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HomeMy WebLinkAbout1904 . . . HILL560ROUGH C~)UNTY HEALTH DEPARTMENT ~ ' 1105 E. KENNEOY BLYO. F,O. 80X 1731 TELEI~MONE 223-13tt Ta?~~n. F~oR~oa ~;~EO~ 26'7923 • - CERTIFICATE OF DEATH - . Iky..~.Kp~ d 1 k.H6 .~d. R~Iwb~lu.u.~ fTAtE f~~e No. ~~~~W+~ FLOAIDA 4 U4 t w~aervn~an~~~ RE616TRAR•s NO. i ECEASFD-NNME ruSt r.opf ~~fr ~x DAiE Oi OEAM ~ rOw~w, ear, ~ea~ ~ , ROY BARTER WALLACE ~Male ~September 17~ 1973 r~CE .wn. N~.:w. •r~.c.M w«.«, wGE-~.~r u..w~ ~.e.~ u.we~ ~ o.~ DAiE Oi ~MMiH ~uO.wM. o~i. C01Mir Oi OEATN nc ~ f~Itw~ ~ ~~~nq~~ ~ r1~~S~ rpf. 4?y wO~Mf rM. nA~ 1 Whi te b2 A . Ma 31 1921 Hillsborou h ~ CIT~/, TOwN, Ot IOCATIpN pi p[AM ~.swf t~ ~rnf MpSMAI p! OiMER NSi1NT1pN-NAMf ~n Mp~ rM e~rw~, a~ve st~etr wrrt~ ~ sncn. .n o~ .w ' n Tam a No ~ Veterans Administration Hospital St~TE Oi NRTy ..o~ w~ u t~., M~rt CITIIEN Of WMA) ~OUNTR1f /NI1tIt1ED. NEVE~ MAdIEO, SU~VINl1('s SlOI1SE ~~t ow, one woer wr~ ~ • cowm ~ ~NDOwED. WVORCEC ~ fnco, Arkansas ~ U.S.A. w Married Gertie Bryant ' soci~u s~cu~+r Hu~R uw•i oca?~Tia+ ~o~.~ ...o o~ .w. oa.. w~.~.w .on a co+o or ~us`.~rtss oR a+ousmr ( ~O~[~MO lMl. !HM M MMlO 1 3~~ 495 32 3112 ~s State of Florida ~ aEStDENCE- SlAiE COUNT~ , iOwll. OR IOCATION r+see un ?r~n STlEET /WD NUM~E ' ~s.ecr. ?es a .w~ Florida St Lucie ort Pierce No ~aRo te 4 Box 42S , r4tr!~-ra~+wE i~ar .~wsu us~ MOTl~R-MADEH NAME rau .~wxf ui, ~5 Jacaes Wallace u Dill Na ~ NfORMANi-N~ME MA1lNG w00RESS ~smer w~.r.~. w, cm w~mrn. u.n. tr~ - Mrs Gertie M Wallace ~n Route 4 Box 425 ort i rce 1 rida 3 450 ?~tt i. oEw1M wwi GusEO ~r: ~[ME~t a+~r o~ uuSE ~Et u+E ?oe hl l?L nwo (c„ rnreer w~sn ~ M•~w rrtsu c~uu FfLc'v r,y; .aED ~ ' • ST.LOC•E i~~+U4; Fl/l. : SEPTICEMIA - . . . ~~E~,,,,,,,. ~ i. ~~itT co..en.o..s. ~r.M.. R~~"'=C VF=!rI~Q , ~YMI(M a..~ ro c~i ~ URINAItY TRACT INFECTION ~ ,r..ts~~~e uuse ~m, p~ ~o, w.s . ca.siwe~+ce a ~ f1~isM( tM~ YMOf~- T IZ 46 ~~13 ~~~~0 C~YF ..s~ $ENIGN PROSTATYC HYPERTROPHY ~ MRt p QTMft SIGNYKANi CONOITIONS~ CO~/pnOnf lpnM~Nu+6 q ol~M wt rWi ~tu~f0 *O t~u1! Gnl1+ w w~ ~ ro~ . ~ ~ES rt~e aro~wcs co«- ~ ~~ts w«o~ w~eus u. wn~r~w~MO uvu ~ or a~~+w Ib 11~ . . ie.oboW)~1 ~CUOE~.t, SUK~OE OR A ?1 1 rOMM. ~t, ~l~~ 1 Ifpl~ MpW INIU~Y OCCURREO f(M(~ l111~ Q/ IM~yA /M /Af~ ~ Of 14ft 11~ fI~Y r~ . NpM1UD[: O[ UNpfif~MlMfO ~so«.hr) . ~0 7M 7k M !Y ' iNJU~Y Ai WORR ltACf Of INIURY u Mort. +~+r, st~ter, iucfon. tp~Anp,l e frren w~ ~.o, wo., an oe ?o~+w, s»n ~ • . i?IC~R ~tf O~ +D~ ONK! MOG .l1C ~S?lC~I~II r ~ 70~ ~ , CERtIFKAt~Orr- +o.n~ w. .eae .o..n. o.. .r.~ Ab VSf L`I MM/M~~ ~~h/[ QM 1 pp/D~C NOi ~4w 7Mf DEATN OCCUNlD •r mc rua, c., e„e r~hry~u~ra: t~ ra.m w. nu wo..m~ ee•+w ~wove~ o.~e....o. ~o n.e ~es~ 7: A~; ;:;;p°.;~Sept. 11, 1473 Sept. 17,1973,,, Sept. 16,'73 Did Not ,,,2:45a.,~. o~'<<l"~;s°;;;,;' Cf~tt~fiUtiOrr-MEOKAI ExAiW?rER Ot CORONER o.. rwe ~.sn a rwe ,qw r«e oeuor~~ .~s no..ou..cto oe•o ' ta•r~w~t.~w W n.t WO~ •aD/O~ rq untSr~~r~p.~, m rr o~ri~pra. ~ rOr~n~ pr~ re~t Mou~ ~ ~t~~M O(CY~~FO OM Mf D~M .«a ovt w n.t c.use~s~ suno 1:• . ~ ~ M. M CE~TiREt-rv,ur~E ~n o~ ~~~.+n SK,IdwTlltE . acnc w r~ne DA E SIGNED ~w..n~. o~.,.e~~~ LtAi~Zu_.~t~Zi~,~, M D r,, Se t Z? 19? MAt(WG ADLI~ESS-CfRUf1FA sn~e+ w ~ r.o ..o ' . an w w.+,. v.n i~r :M ~~eterans Administration Hos ital 1 000 North th e eur~t CREMATipN. REMOYAI t~r[er qe ceteuio~r-N,~,wt touno?~ c~~ o. a.... s..n t;"`M'REt~;OVAL N, HILLCREST MF1~IO~tIAL G DENS, ST. LU ~ C FT. DyTE y. y y~-_... , R~~~ N AN L•~~ l l V l• 1~ t/ V~•rIIO• V[ 1 S ~ - 1"; tUNElA REQ AiURf Al~JR[ DA~E IVED IOC~ , lGISIRA! 7 H ~ L }N _ ~C 7~ ~,/+Mww~ I}iERF,BY CERTIFY TNE AAOVE TO BE A TRUE AND CORRF:CT COPY ~~"T OF THF, LOCAL REGISTRI~R' S RECORD ON FILE IN THE NIGLSROROUGN ~ COIINTY HEALTN DEPARTN~NT AT TAMPA, FLORIDA (WARNING: NOT "`x'~=r~~?' VALID tAVLESS RAISED SEAL OF TNE HILLSBOROUGH COUNTY HEAI.TH ~ t DEPART[~NT IS AFFI - . .-c~' : '!J - c , . ' Jc~hn S. Neill, M.D., .P.}{:, irertc?r - x ` : , :,`.-y,. :r ; - ~County 1{ealth Officer & I,ocal Registrar . s~?f ' ~ SEP ~ ? 1973 C ° '~P~ ,'S~ , r~ t'' DF.PUfY RFG RAR ~~R ~ , ~ -