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HomeMy WebLinkAbout0534 ' ~ • . • _ ~ DADF COUNTY ~ . , - DEPARTMENT OF PUBLIC HEALTH , 1350 N. W. FOURTEENTN STRt~T ~t~.TON S. SA4LAW, MD. MPM, r • (71RECTOR I . . MIAMI~ FLORIDA 33125 = ~ . 2 . _ ~ ~991 I:;H$R~BY ~CBRT]~r'~4~44~IS TO BE A TRUE COPY OF ~E I.OCAL REGISTRAR'S RSCORD QF ~ATH. ' f - ' ~ • ~ ~ : ~f~it'C;' ~`,a • ` ~~j . r .a~ , , ~ S-~r ~ ~ ` • ~r A~ItJG: . . ~~T ~ ',(I~lot :valid unless the raised seal . DEPUTY REGISTRA ~ _ ~~'<<.•$~.t;~ : _ :bf the Bureau of Vital Statistics VITAL 12ECORDS UNIT : ~ ; , 1.•---r;!-, s' . is af f ixed D~ADE COUNTY HEALTH D~EPARTi~NT ~'L ys',~r.. j i . ` ~ MIAMZ, FLORIDA : , ~~~';~~:~:i; _ . _ .,r.~ C~RTIF[CATE OF DEATH tk~b.~~„~„~ o( ik.le6..d tt~lwu.e 5~..~tce. srwtt F~~c Ho_ ~~~'~+~~w~~+ FLORIDA n °~°~~~'Qam~ REGlSTRAR~S NO. ~i~J?_~ '~L.in~~p --rvnn~f . ~•s~ SE7t D~iE OF pE~M ( YOMIM, D~~~ ~e.~~ SAMUEL BISCOE , MAL.~ , F~BRUi,RY 22-197'3 ~ re. a[G~O. ~+[nur~ ~..c~.n, wGf-~.u 1.~.~~~ ~ rt~~ un0[t ~ o.~ DATE Of dIRTM ~.~ol.rw, o~r. ,COUNTY OF DEAiN ~ ' s.ec~r. • n~rna~e n[us~l rOS~ O~~s ~~s ; tiw ~ i~;HITE 72 s? ~ k ~ AUG. 25, 1900 DADE ~+.N, OR tOCAi1pN OF DEATM u+iwe c~n iu.~n MpSpITAI OR OTHER NSTItUT1pN-Nnti+E ~~r r,o! ~w t~r~n, ~nc SraF~ •rw ..u..sr~ ~ S?FCIIT ~ES O~ MO . i~II~Q L, YFS VETERAIJS AIIMINISTRATION I{OS~ITAL !!RM ~ u.aoi u: u.i w•rt CITIZEN OF WMAT COUNTRY MARRIfO, NfwER M,tRR1ED, +SURYIVMiC, SPOt:SE ..+rt, c~re .,~wF.. wwt ~ cou.~n. i w~DO D DN O i vec:~. i ' ~ PENNSYLVANIA ~ U.S.A._ M~#RI~~ l„ CATHERINE CQMCO~~IICH 5'.CURIfY tP,iMlfR USUAL OCCUPATION ~wve ~wo or r+ou oo..E c,n~..c ..os~ a Kk1p OF 6USINE55 OR lNpUSTRY wou~w ur[, tve.. ~r ~tr,~eo ~ O! -0 02 MEAT IPISF~CTCR CIVIL SERVICE, AGRI. DEPT. - . _ E'.CE --SiAif cour+rr ! Crtr, tow?a. at totwnUri ws+Dt Cm cr.rtt ST4EET AND NUM6fR jlYf[~~r ~FS O~ MOI ORIDti ~w ST. LUCIE ik FORT PIr.~?.CE ~w 301 BRQOKi•INE AVE!':UF ~ ~ Natirt n~s~ - ..~pw[ usi MOTMER-MAIOfN NAINE ~itsr ..~owe ~ usr ANT3R~,'W BISCOr. HII.Etl SWEPZ ~ '~~!)~1MANi-NAINE Ilu~• taken fro ~~~~'~~~SS :srttl~O~a.~.o .w.or.piro~~,s~.~e.r~~ ~'.u';~. WILLIAM.S VA Records ~n VdEi 1201 N.W. 16th ST., MIAMI, FLA. ~ ~ ~ ?rrwuwr ~w [ ~ OEATIi WAS CAUSEO 6Y: (EHfER ONtY ONE UUSF IfR !!Nf fOR (o), (b1, A/MD ~lTatt++ owslt ~Np Dt~n~ ~ e _ WrtD~wlt C~U1t _ ~ ~~~>>I-1 C, 1112 F-1 YT/-~ I~t ~ l~ j a , .s . ..uou~ace o, ~ ~~se ro (b) ~~7 - ~ ~ Ccfi.GL~irI~G fZ=~~~+ (,r~~ci~C i '.~c c use ~m. oue ro. o~ .s . co..sea.,~»cs o~ - - + : ~~E MDf~~ ~ . . ~~•ulf I~S~ - t" kCA.~if~~j ~~I~~t t-~~C ~cC~r~E_~S _ OT~tfR SiSi!~tifK~r~T CONDiT~ONS ~o~+auo..s co•rt~uunwc ro u.r.~ ~ur ..or ~n.~EO ro c,usc uNE~ ~k ..n ~ o: AUTO?S~ if YES MFIIE ~iND~Np3 Ca{• ~ri1 O~ O~ S~DE~tD Ip Dl~t~r!.+~MG Cf:/f~ ~ a ~ ~ f 11 ~ ~ , ~ a of.~~ . ~ - •CCIDFNT. 511(C1DE OR ATE Of IN1U T i rOtirn. w~, r[.~ ~ HOUR . :~i, OR UNDEIEUMiNFD MO~M IN)URY OCCURREU `EMtt~ ruruee cr iwiw. ~n ?.~i ~ oe r~~: ~i, rttr i . ~ ~ l0a M. ]01 . '~?T wpRK KACE OF WA1RY •t wore, r~u., sran, r.aon, ~p~At10N ~ u~et~ o~ ~ ~ o. r+o , c~n o~ to~+~. s~•~F ~ rFl Ot w01 pfiK! NDG.,[iC IYECIAt ~ ~ ~ ~~..ATI~N- +0~~'w D~~ ~F~~ ~ ~OHM D~~ ?E~l wwp 45~ L1w ww/wE~ ~ltv~ pN ~ pq/p~D ti01 riEVr tnE DEA~N OCCU[tE0 M~ ?y(f, O.: M! • _ .".aN ~O rOWTM DA~ ~l~t • ~ ~~it~ Ol~M - (y7 oo ~»o~.~ o.f~. ..+o. ro n~e wsi t' ~ h•"EvJ[D Tw[ Feb 22 1 ~'eb 22 ~7 ( 3 , Arjt~ ~ io5a OI r~ [rprlfpGt. pyf ~nF,t~SFD ~tOr dan 22, 1973 , 973 , ~ c tte M 70 ME C~~H~b s~•no. .~:~atiON-iME01CAl EXAMINER OR CORONER o.. rwe ~.s~s o. r~e „a~ a~ a.M Mt DKEDEnt ...s rp..o,,,.cto ou~ f . _w pr INF qp~ ~MO/Ot TM MnESlr~iqN. ~w r~ q.N~pw. Wr~ M 0~~ r(~~ wpuf E '~..~~tD OM M! O~'! ~ND O11! M~Mf U.uSt~S~ S•~*FD ~I . M ~ t7? : V~C .'(~oc r T 7-3 M- E~- ~+M+E :nn o~ ru..n , SIGNATURE ' D Gttt q m,e ~ DATE SIGNED ~••o~*~ c.., •fut~ ; ~::~~i::AliL ELSER M.D. CC~t«~~ f~t ' l~ ~r~ 2-22-7~ ~ .-.'.~v wDORESS-CfRilitER VAH 1201 N.W: ~~~i~t~i' ~RE ~ rY$~"~ FLORY~`A 331~5 € , EMAj1pN, RE Al CfMETERY OR CREMATCRT-N~uvE IOC~TiON [~n o~ ~o+... si.~t Hillcrest Cemetery 7,< Ft Picrce, F'lorida_ ~4= tlIW~1N, Dkt, tE4t1 WNERAI HOME-NI4• D AODRfSS ~ Si~~Fi O~ t./.D NO . Ct~t p! MN. ST~TI. I~/ 1 ~ s ~ z; 22 73 n. AIRD F.H. 901 N. 7th St. Ft• Pierce I~lorida `'-^`-R~` Q~ ~ / Cit'iS ~i~ owie eK[+r v ~r iota? ~~S~Z tg73 € ; ~ ~ r t~ ,w ' ; _ T _ . . . _ _ F ~ i,~~E : ' ~ ^ +t ~ r - ~ . I F i:... '~~...e~..~.:~~,..~,_..~~ . ~ , . , n, yd , _ , _ _ s~»~ ~xc~: ~