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HomeMy WebLinkAbout0965 26'7283 : ~ r ~ - ~ . , Y CERTIFICATE OF DEATH , Diep~rtwewl ~1 Iksll~ awd IZe~61H1~live $e~kes fTATE FIL[ NO. rn.~c~«.~i.rn FLORIDA ~ trfE. OR ~tlNi IM ~'~~~"~'~O REGI6TRAq•i NO. rjnn HtMANINt INK ~^N~ rNU ,,.~eu a~f~ ~X OwtE Of OEwTM ~YON1M~ o.~, ~eu~ S[i NY~i00[ i0~ ~ RUTH CLIZaB~TH Pi~OCTOR * remale ~ October 23 1973 - ute •n.~e. .NO.o. .r.K..~ ~cc-~» ~ a,. o~rE a wrN ~.~a... e... couHtr a awrn ~x. ~ wcrr i weM~~ ~.w~~ .os. e.n wun n•~ ~ ~ Nlhite S1 u ,Dec.l6 1922 Saint Lucie CIlY, TOWN. O! IOCATION DEI1iM raw cw~ ~r~M MOSMAI O~ OMEt NSTIMION- ~r wt w imn~, 6m a~r~t ue wu.rt~ ~ sncrr .~i o~ w ' ~ Fort Pierce Yes Hort ?ierce r~iemorial Hos itaZ STA1E Of MttM i r.ro~ r~ ~.s.•.. rw flZEN Oi ww?T COU~Ari wuRpED. MEVER ~t0. SlAVrvr~G SIOIKE ~ r wr. o.+e .uwM ww ~ tow~+~ WIOOWEG. 01MORQD ~ vet+n ~ ~w....+«~. \ecv York • USA w t~+.arried I-:enr ~ C P o to •~ew wee.se~ SOCw SK1Nrt~ MIwEt uSUwl OCCW~T~Ow ~u.e ~.a a w~ sow w~wo rov a RN+D OF MlSO+ESS Ot K+OUSTRr u.a. r w~M xtwe~ .,o~w uw. we.. r aTMe~ ~ ~"'"^^iOw.~"' 098-I4-~788 u,_ Cataloa Sales n?. netail nww»ce ~eror r.aw twr u.m STtEfi Mi0 NUWEt ~w~s~or. lfS1OflKE-S1ATE COINR~ C1iY. tOwN. O! IOCAiWN t _ ~ v~cw. n? a wo ~N : loxida ~w St. Lucie ~k Fort Pierce ~'es 1100 Pine Avenue iAiNER-HAME ~Ipt r~eoat uu M07MEt-MA1DfN NAME erw wae utt ~s John Hof fman u n~ n ~HFO~MA?If-ti~ME w?4wG M6~ES5 ~urs~ w~.ra. w., crt+ w ro...~, a•w. tr~ Henr C. Proctor ~n].100 Pine Aveo Ft. Pierce F1 33450 ?A~i L pEAM WAS CAUSEC {Y: (ENtER OMY ONE UUSE IE~ IIHE id urW~w? ~~w t~ru hl. M1! A?~D (t?j uivree~ OMt7 ww~ q~m q w : ' ~ ~i NI . '.''c /1~.lC~ t t/ ~-1 ~t ~ ~ ~ . ' - , ~ ' coMNna.:i. a.n, / ~ • ~ ~ ~ ~ ~ . J~ ' w¦~cw o~~~ ~~se w + (el I ~ ~i f ~ ~ i_-Z: ~ / //c : / - G=~- ~~i~--a-. ~rrtN~ry C~YSt NI, « A~y~~~! d: 11a?~MO /w! Y/~M~• ~ ' ~nMO C~Yl~ l~lt ~ ~ t ~ / r ~ 1 / .i.~~ ' i;.-s ; / T .,~c-~-. ~ ~ ~ ?A!t OTtE~ SIGt~~fIC~NT CON01T10N5~ eonana.s eo.wu~w~.a ro o~n. w~ .w~ ~eum ro uvw em+ ru~ ~~u , ~dSr tf 1/f5 ~++~e .e..s,«as ea.- u ~ns .a~ rwae~ u. N~euu.wo e.wsa a ee.iM ~ S iw S {~..!e?~ KdDE ~~owrw. wr, r~u~ NOW INIUlY OCCUitEO ~~•m~ wnw~ o~'~wwn w r~~t ~ M rlu4 N, inr 140t~ p! 1?~D~TtfM~MED . ~ ~M 7M[ M. ?.lf ~ ~N1Ul~ AT M~ORR MwtE Oi N1UR~.~ now. s+~n. ~.nw~, tOCwiION ~ snee~ w~_r.e. Mo.. tm o~ w.w, u~w ~ ~ f?~an nf a.w ~ a~~a wo.. nc. ~ vrcr. ~ ' ~s ~ ~M ~Rt~flGltqN- .or~w r~ nu ro..r w~ ~w ue usr yr wr/.w~ um a.~ ~1r/ao no~ .~e.? se oewiN oCtuu~o .r nu ~ucr, o.. ~.e ~ ~MrsKuw: TO ror~w wr nu wn uttnOt ,~1 •`3 ~~p•n. •~•o. M wr ~esr . n.. etu uesM~r 1 II~ r'~ 71c ZV ~2~~ / J t7 tl•. ronni.~i~ii:nu ; CEfTIfKAT10N-rrEDiCJ1l EAA~wER O! tO~OtrER: o.. n.~ ~.a.s a ny .ow a x.a n.a eeua .r~a r~o~.w..ce~ w•s ~ ! ~~u~~+~no~ W w4 W~r ur/W twt rvtsnwriow, w~ w dr~d.. rOnM e~r ~w ww• ' w.w. oaw~ro d. wr wn .Iw ~ue ~o we uvu~ s~.n~ 11: 3~ I? m 10 - 2 3- 7 3 11: 3 5 b. r.: . M ; ~ / u w nne DATE SIGNED ~w~+a, wr. •eu~ ~ CftTIfM R-NAME ~Me w rp.n SIGNATURE. . John Sir~s :i. L. PA ~ - ~ - -"r ~ ~ ~ ~ 1G 26 73 s~~en u...o w em o~ waN sr~n tw ~ ~`N`6'"~~i~:"o~~h Street / 'r'ort Pierce I'loriaa 3345C ' WlIAt. QEW1TqN. IIEMOvAI CFMEtERY 01 CtEMATORY-~w~E IOGiWN c~n w w~r.. u.n ~ Burial ,idillcrest ::em. Gardens x~. Fort Pierce Florida ; Oct.~~, ~~~73 ,~~Yates Fu e a~ I~orce,~~Box~~77,iFt.~nPierce, F1 33450 ~ v. 5. a612 ~ wtECTOt-s~t~tu~1E----- reG~sT -S+GN~rur[ owtt iect~veo n?oW eee~srw € R~v. 1970 ~p - ' ! j~ ~~L N. ~ n ct ~ fltEi~ a!,° ?tf C~RUEO ~ hsroby osrtify this to b~ e trw end oon+sci copy of ths LOCS~T. LUCt~ .'~U~tTY FtA. ` Reqistrers naord on fii~ tn fM St. Lucf~ County H~ehfi FCZ' =*"-qAS ' msnt at Fo+'t Pieru, flo?Id~. ~~tE ~t~' ~OUqt ~~C, , . . . . R~~~ ' ~1=- p 1~;{~:: . (YVaminy: Not vaJid unlsc~ raissd sea! of the SJ. Luci~ nAi ~O i„ r' O~':•;' _z ,:o r :..t. County "Health Oeputment is sffixed.) V!, 1~ - ~ ~ e IV~ / MV~J ~ ' . `''1•~,% ~ . - . N. MILIER, AA. D. : s- Health Officer b locel Registrsr • ~ . : ~ _ ~ J, .,rs ~ : d~ r~'r~: f'u.}= ~ 4 ~ j ~ ~ ~ ~ ! a o i:: 4':~ : ' pa~ O~puW taal Rea~. ~ ~r , - i ~ ~S ~ ; sh i ~ . r~~ CU~~ ~-~.+iJ Af.? ~ - ~ - - - - i 1