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HomeMy WebLinkAbout1462 CERTlFiCATE O~ DEATH ~ / ~ar~aflmrrt u~ ~~~alt{i and F:~~~+~~~~~Ia1nr ~rnice. STATE~ FiIE tQ0 ~N~ „a ~ F L O R I D A - . ttw~ s mu n.ns~xa pEG16TRAR'S NO '~'Sl ~`~~'~-NAMt •~Si .~.t • f _.~F ~ - ~ i E• ;Gw1E C> u:~Tti c.. ! i:~or~e 3. Cr~el ~ re~ruury <4, 1; ;Jr ~ U~E ww.q .e~~-. art~ _.v .r„ AGE ~-r. ~ --'--r------`-~ ~ . . •S• ! t ~ OA? ~ B,FTn - ~ ~ ~ E C [ COUNiY pi JFA(N e•; iie;n- ~ ..r• •e.~ ' ~ ; i •~A~ ~ff , ~t,~L~ ,,"5~ ~ t„'e~t. 1~,~t~,~ ~k~r 26 ~i ~ :tTr. 10'xN 04 lCLA1~G~: OF DEwrM ~ ~ ,ce -a~~•i e_Si:•a: CF ..IhiR V`51~:7;,I.Jt~:- •..v.•. ~ „•~.e~, s•tt.- ~ ...u~ : ~s •e:=.~e1 „ t~:acc~enr~•, Ficric3~ :~o horzher:s ~ rlcrida ~ta ~e I:cspi ~~.1 7ATE Oi 6:iFN ao+ _ ~.«e~C~S~ZE~.. C~ wn~- - _ e G 5o'G -t 5 ~ u s, .~c,r.•c• .w~svc:G r~E~ia rruReiO S.: r~vr: USE .:~f c..-e ,,.~ee - ...~c ; ~o ~w yv.iD. CED vtc.:. , •%oLt~.~, nlabumr:J li. r . ~~:rr~e~` l:e12 ~s. C: ~el ~ :'.,`CtAl SECutl7Y t1GML[R ~ ' _ _ _ 2"_- _ _ _ _ _ ' . _ . •USUAI OCIi;D~' ;_;N • n..; ~._a. _ : c_~ -w ~cs~ c• K~t~tC C~ 6i;5~Nf5S CR in.^.~5t~~ G~~~~Y . t~~ ~f" ~ ~nl~cun Fcrner ?.~igwccctr jvlp~oc:: ~ - _ _ _ _ _ . - - ~ RfSIC ~CE ~TA!F ~CG',;N'r . 1~~nV.q~ ~~~Tl~t. I~~~:~ntt~n u...r1 ISTFEET AN~ t:~MEFR ~ ~ ~'larid~ ; S~. iLCie r - . Y~@FCE , l•,` ,•z . ~ j~is r ?88 ~%~4 N.~~Z~22' RCB:: . i ~.Ir1ER-~.AME ftlS' ~..a7~E a.5' .MGSMf~~-AUiL~[N'.A.Y.: ~~5' r~C;.~.f iai' j UA~I',O:Tri U21kt2Qi~fT2 ~IiFARMAKT-- n:AMF :it-~', - . ~utING .tDLRE$~ . i-+Et* ca r~ H~ ~r. oa c L :c~•. s.•r z,r. i.illie N',ae F.r.oden tiortheast Florida State Hosgit,~1 P.R i DEA7N WA~ UUS~D t'~ ~F•,-:~ ;~.~,:r ,-yF <a~_cE ~E~ ti•:F c<_~. ~Dr . .rrn;,~.ur~ ti.er.,: 0 ~ c~ie* . + ot.~r ~ . _ - - - ' , - u~WL.~tE C~_:! Cerebral thre~besis f1~[D ~k_~ ac~~~Ft>EO ; 4 dsys ~ 4~F St. ~UC: ~:lN~Y F~,~. c.r--~. ,-s . eo..a_.e~•_. _ ~ ` N~~M v~YE ' ~ . rrzerio~cleresis Qr Ci E~~. - r.G~RT ~'I z ~ link~own , ~ - ~ .r.1LC:~'~ t' F C 1 - ~ C.: _ _ ' ~ ~ _ - ' _ ~T ~w~ ' _ _ _ _ ' . _ _ . _ ' :,.,,N~ ;..i~,. 26'7655 ~ l~iw; :~.SE _ 1 ~ - w - - _ _ _ No~ 5 _ 9 ~~~N'~;~ ; "Q' OT ER S .:~`Ka.ta' CC .•,•.5 c ' ?.s e..~rt:• . - r~ .-eo e . . ! ° S ; esqr o: ~ s~o[t[o ce~~ au.a ::rga~ic br2in £y': uI~C~:.E: ~`C~".: GIZ:.C 15C~1E~1.C rie rt d`ise~ e•, ~ j~UtOP~r If •E5 c~~ •w^ s c +t 1~0 1 0• cur~ ! _ . _ . ~ . - -~'s - ~ t~D .•iO~M C'}' +~~~1 ...T SL'y ~Cf C7 ~ATE GF~ i~ •r~~ ~ fN"''0 ~HOW IfJ/i:RT CC:ORR:.. '.~t cr ~ .:Uer v r~~• _~t ~•r ~ 1 ~~ec.f~t ~ ~ ~ =A f2. M!~ j ~vRiRY A: N'GX 7JlCE Ci . ..R• w:. .t~ . ' ' _ . . ~ , H s.ee•. .es ea . io•ncr r::.. --se:c~~ . ~ tCu'~1:~~r: u.ee: o. . c . s>.,e . I I 7M t ~CcRTlF"~.t'.~N-- ~ ca• .t.~ .c+v-- e.. .e.e .~a us• S•~• . ~.e ! • D~D:~~t[ M_.T r'Ew Twf' CEATM C~CUtt:D . n.t r..ce. o•. ~.t . .•-:..a[. ; w.. +r { .H,,~: .v Feb. 11 , 1~70 'o 're~. e4, iLli ~ l~e~'i. ~~.";1 y1`Q , -~'~i~`.~, .15p ~~':..'~~..~:~r: ; n^.. -'1 17 , - • . :d Ip'r ~ *c rr! c. . ~ . . _ _ ' ~M SE 5 ~ ~Fk.i.:Cf.:i~t1-N.Fi.1~R! ERANiNEQQCCO£L"`.`.~ =•.t • ~••t;--.. .V.^.--..-_'--- ' _ . 1.:t _ n nE Cf~E^ . Il:.~4C~_~.'_[~ _ , ~:tr'vs'_r'+'MF k'.'~~ lx v~ •Nf ~..I:'._.~'~p~. • _ Y.C-' ' M.. M .E~~ wp. • ~ _ _;~~t1[: C^~ '`:E D~'i ~n_ :~.'.E "r[ :~..~.5. ; ~`t", ~ . _ "_'M _ ~iS M ~ D - ~ cec~tE oe •.r.~ - A7E 5!GNED ~ no..rr. ; ~ ~`"'~fa°r~riii '"Mt`eY1'~an, r.. , ='`N~•~'~ - - - `n• "~1,, Feb. 25,~ 1 y`IO ~ ~~i~~:,~^^RESS- rp! q - s=n~- n~. ,...e - - ~~L cr~~heas~ ~oricia Ste`„e Eospital, ~.~cclenny, rlorfda 3<Ob;~~' . . ~ ~ ~ 3.,.,xt~ER_n~.. v . rifV, YA_ ~CENE~£aT ~:A _CiNA,v -..~yF :iCt:.?!;.y ot • ~ i ' , ~ , s , E r sn p~ ~ ~l r / ~~~n-c"tr'~`-`,• _ L~~, ~ r,~.~C:.l~.~ j•~- -~S~c,(~k ~ . :x-~ - - :~~Q:_ M~.,:~ ~ ~ t«, s:..~. . , ~~X--.; r~ ; ~ c ~n.._. re ~ :a• ~.t,.~/.~~ ~y y, _ ~ - ~i;~a ~ ~ - ' , F M(-.t7 ` ~'`1 ~r:4d f °:R. - Ff:,.5ipr12: ._ry• . ~~_..S.s.. - ~ _ , f ~ l 1 J- T / i[~ : . Cs~. r r ! Y~-~ ~ " T ~T~~.~ l. ~ L'" .`i rt.~- d: ~ . ; . _ Jr~~~~ ~y`~ ' - - - - - : ~ c t . w CERT1FIED COPY ~ . .is,-..: l.^ . = ~ v_: z ' e-~:~NERf~~3R C~~~Y''T~iE ABOVE TO BE A TRI.£ AND CORRECT COPY OF THE ORlGINAL ~R~J~(jl ~GN•~:*'I~.P.~ji~l TFtE EUREAU OF VITAL STATiSTtCS OF THE STATE OF FLORIDA. ~_~~~ARfME~T,y`C~~F1~¢tTH AhC REHABILITAT!VE SERVtCES, blVIS~ON OF HEALTH AT ~ . a ~ ;~.:~l?~itS~~yu,;ii~, ;,~tgi~TDa. .+M T• ,~t,f{~_;~~~~ SEAL OF TsrE STATE C~ F~'JF7C4 CEP~RTM,FNT QF NEA~TH AND RENABlLfTATJVE ~J•'~~ j~~~~~ I: ~ , HEAL~'? (5 AFFIY.ED ~ ~~tIQNN , , > . : ~~~e~u~ ~~,~>~~„Q,I)'yl,Q ~ ~ ~ MA~ ~~y~ ~ ~ HJRE)V ii' Vr:~L c`~TIS';~5 J~:. ~ ~ 1 ~W~ ST~'E FE[.~~" ~ L~ ~E: i~`~.,:c'.~r~. L ~ f I NEAITM - GE~'Ap'4ftiT OF r~F~~*1~ ?f.(~ r ~iEMA8iLr7/1Tt~C SEFV'CES 6Ctr ~'a(~E1~J9