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HomeMy WebLinkAbout1366 CERT!F!cqTE OF DEATt-~ fTATE FIL[ NO._ ~~dwrul u~ ~ ~ta~lb r~ k~~aa~d~ildi~~ ~nvi~ri F L O A I D A ~ - IN\ LVIIN OF IM_~I 111 ~r?E, O~ ~hN~ IN ~'~O~~u~~~~ REGItTRAR•S NO. i'tRMA~IiT INII ~EwSED-~+4ME •~~s~ ~wc~~ us+ 5Fx Dw7f Of QF+tin ~ YOM~M_ Oa~. 1~~~ ~ SEE N1~100~ FOt ~T~~ ~ J~Ea TRITTON ? MALE ~~TEYg~R ~~1~.T~,.-.---- RACE ~~~if. wlGW. ~rlnc~~ ~~O~~ti AGf--uit v~+W~ ~ rrt~• V.Ml~ ~ O~• OATf OF NRM ~+d~~w, Oa~~Q~JN1Y OF DEAIH frC ~ SHC~r~ ~ ~~~rwO~r i~l~tf ~ r01 t Wri ~HS ~ rw ~ ~ WH~~E-- ~'-Il-- w ~ w • f 1[ei ~~e~ ~ - - ~ CRr. TOW~'1. OR IOCAl1ON Of OfA~H MSIO~ UI~ IWNS MOSMiAI OR OiMER NSi UTI I1M[ ~n ~a ~N 1~1MI\, 61YI stq~i ~ro r.owe~ ~ O Sqc r? ~t o~ rM • . ' _ ~ OAYTONA E3EACH YE$. HALIEAX Q18T CT H~Q#P~~wl. - - Si~iE Of WtM ~~r Not v a~.~+~re QT12EN Of WHA1 COUNTR~ MURtlfO. NEVER MAlR~EO. ll~ry ~~r ~u~. c~~ r~oe~ w+~ + ~qn.n. ~ WIOOWfU. ONORCED ~ srrtv ~ ~s~.~.esw.K. ~ Et~ql.Af~D + USA MARRIED ETTA MI1EtlE .~en oea~seo Sp~lAl SECt/MT? NUM~ER USUAI OCCtI~A?!~N ~w.e ~wo o~ .wi oo..e ow~..c .r~v or KWO Of M/SINESS OR I?~DUSTRY u~to u pt~n. occun:o w •~M, M~ ¦~~'~ro r ,.sr~TUna+. o~.e 262-0 A 1 NI SHER -~ARI ~e?:oe«a uron - - - •o'+~+~~« [ESIOENCE-STAfE COUNiY CIT~, tOWN. O! IOCATtOrr W+~ ~m ~W~n ~STREET ~NO NUWER ~ ~ s?eu.•_•es o~ .~0 /I - ~a FLORIDA ~u VO S A ~k P FwTHE~ -?~~E r~a~ ..~oo~e i•s~ h?OiHER-~u~OEro ?~UwE .w. .~oae us~ ~s JAME6 LMIBERT TRITTON ELI2ADETH LYD A NOA E INfORb1ANT-NM1E MARWG ADG~fSS unen o~ o ..o . ur. o~ •o.~, sr.n. rr~ ...RS•ETTA M/! . . ? I~Y IM y ~~1~~ pfAi/1 WAS CAUSEO ~Y (ENTER ON11' (N~lf C~USE VER IYiE FC~ (o), 10), A~ k)( u~w~ew p..fli awa eEa~ q r...eoun c•vse'~-- ------T- f1~~r ~1 _ 't.t ~ • L,~; c ~ t~ i L~.: b~ ,r `1 ST.1.UC~: ~JJNTY FIA. F. '~''AS' v . .s.c .+u ~ ro. , Cli ti~ - • co..omo~s. u .M., _ . ' ~rM~tw c.vt ~~se ~o (bl . - ..~o,.« ,o,. f o~. ~a. ~ . ~~~u~~,.~, a - - _ _ _ - ~ ~M 13 ~.o~. No~ 2 t0 s ,2 26'7592 _ _ ~ART B OTHER SIGNUKANT CONOITIONS cp+a~~o~e co«+e~~~~~r.c ~o ou~w w~ ..o+ ni••m ~o c.u~e •:~rw .•~t ~ cn~ AUTO?S~ ~ If YES ~iet ~~.o~w6! to..~ - ~ ~a d wo~ s~ot~eo ~N wie~rn.wo uus~ q Of~IM I • (~p I tw ~ {ho~eW~ 1 ~CCIDENT. SUIf10E O! OAiE ~ WRltll ~ ro~.*~ w~, ~ NOUR ~NOW IN1URt UCCURlEO ~ t~n~ r.,~un or ~..~u~• rut ~ o~ nn u. mr ~ p n~ppµ~cKjpE_ p! yNpEiERl~urf0~ ~ ~ ]Oo ~M' 7ii M TM q ~r, S1M~1. 1K10~~. F IlWRY Ai WORK ~IACE Oi WNAY.~ ~cre. IOCAiION ~ s~~ee~ o~ ~ ~ o .w . c~i• o~ to~~, s+~~f ~ 11~f6~n ~fS O~ w0~ pN~C! ~aDG , ~K ~YNN~ ~ 3 7~1 7M ~ ~ oc•rN occuneo G tERI1FKw~~ON- +wT~ o.. n•~ ..o.~n. o.~ .e•~ •.a us. s~w ..u.~w~ .i~.t o.. ~ s~lo~o r.o~ •~e.r rr.e a.t ?uce. o.+ ~.u /M7S~CIAM~. rO~~1M D~~ ii~~ ~OC~ OI~M In[~UI' D~R. M+O. ~O 4f~ ~ ~ .rte..oto ~~e 1 ? i0 j~ ~ ~ 1-~ w rr iw•ntow ow ~ tb oe<e.sw .¦o. -1- •1 i-• ~ ~ ~JD _ " ~ V 7~~ ~ l~ 1, ~N 74 _ M~o n.t ewse~s~ n.-ee CERTIfKrT~ON-MFDK~t Ex~~+ER OR CORONER o.. *.e ~,~~s,tr.~"; ~.oue or oe•r. ~«e oeeFU..~ w~! /MMOVMCID Dt~D ~ ~au~ww~~0.~ Or rw! qOr ~~aplo~ tW ~HrISiK.~~~ON. ~H r• ~Nn~iOr.. +O1+tw D~• ..OU~ p~~rw p(CyflfD d+ M! D~ry ~MO GV1 ~O ~W C~VSI+S' 5~~~lD ~ ~ _ ' ' ~ ~ .~~7~ ' ~ " . M , ~ - -p ' TDATE SIW~ED ~•c~t+, o....tu~ CfRTiHER-N4ME ~nR O~ n~wu f~l '1 SK~?1~{1yRF' i, .-rv ~ 6~M~ ~ _ Eow~RO A.F~v_~s~ P.A. M.D. . ~ U,, ~ ~ ~ n ~ I---L`~' 1~3 ~ NuKINC, SS-CEtt~fKR s+ne~ o~ o..o e~n oi ~o.... sr.n +u ~ 3 i.~o ~ ~ {utlA~, (.lEµAtqM, qEw?pVAI CEMEiERY OR CREMAtORY--?~AMf lOC ON c~+. o~ ~o.... sun ~ vean ~ ~ zw FtEM{OVAI. t~? Ft en~ ~~~pgj~_ t~~ CORAL GABLEB~ FL4BLiLA_- _ OATf ~..or++M, o.•. .e•~ ~ ~UNERAI HOMf NAMf AND AOORESS ~ sn~n o~ ~ r o »o , en~ o~ ~o~.., v•re. t~? ~ ~ ,y _ APEL~ O S UO~WC~OD AVE•~ 1':C.IA 3CH.~FLA. D~tE ~E co ocwi ~s w~ y~ V. S. ! b I' f lM Al OR- ~ ~/1 REGI R- Sl:,N1~1l~f ~ ~ A e r. 19 T G tA Llu'7 ~ ~,c-• • !N - - - - . 'a - ~ - ':r ~a CERTIr IED COPY - - We he~eb~ certi£y the above to be a true and correct copy of the LoEal ~#i,~~~'strar' s record on file in the Volusia County Health De~iar'tmyeYl$(~~:,Daytona Beach~ Florida. . ~.3 :n - • r-' ~No# v$3,id unless the seal of the Volusia County Health ~ - - - ~ =De~sartment is affixed. ~t- : : • _ . ~s ~ .,'r.~~;' , '~i`p ~ ' 1 •f ~ • . ' ' v? ' ~ I R~', . ,7 .l~.~ .t'- ~ ~ ``~L. ' ~ - SEp 25 1973 Loc31 Registra _ Date : ~ . '~~l~ ~.c.- ~ I ~~y Deputy Regi strar 8p0~t~.~•V PAGE 1 ! I , ; ; _