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HomeMy WebLinkAbout2324 2681~~~`~. - . - _ - . - ~ ~ . . t~~s D~- KAT[ ¦owwo o. Nrw~TM =RTIFICATE OF DEATH eo~~• • ~URGU OF YIT/1L RATIfT1C~ fTATt RIL[ NO. i•a•~ FLOHIDA ord saen B1RTN NO. REGIiTRAR•• No. 391 Prop~rl~ GODi HO. 2. YWAL ~ItNOtNCtlwaw.Mr..dA../ l/:..wwnw: l+it~r?~M+~i:ri~) • •i~ttlt~d 1. KAC~ Oi O[ATM STATE 0011Nr ' .°e .~1~ `O01M1T1St. Lucie 66-025 Florida St Lucie ~ s. ~i.e.e t. K QE51pEMCE ~ ~ w p~~- tmr. TowM.o~ ~ouTpN t. K?I~CE Oi OEATN aTr. TOX11.011 IOCAT10i1 ~~OE [~TI L~r~Rt __=~i I 111510! {.Ii-i uiil`I~i I I . i i i~. F't. P1e2~C@ res U No Q9 ~ P1eYC@ res U w i~$ . 1. 1U1ME OF (!f tMt b Mqihf. /ie'Wtd MIrw1 ~ 1E116TM Of I. STlIEET AOOR[SS ON A FMMI ' ~n*~ 1401 S. 331d St. s~T~r w ~e 1401 S. 331d St. "ES0 "o a. ~u?nc e? M.w ru~r. Lwf DATE u..a ar r~a ,r,.r~ - David Casner Hall ~*N Nov. ~ 5 1963 S. SEIt i. OOIOA OA wACE 7. IuRll~EO ~ I~EVE~ MA4111[0 DATE Of NRTN AGE (h /tM1 ~I uMO[I11 ~W WE~ U M1lf. tae ewNn1 r..w oa. s... xw. ~ ~ i e• Male White ~nooreo ? avo~ccn Julv 8 1913 50 pl~lol~ 10~. YSWIOCCU?ATIOw(QMtUM~Jwrl~wt IOO.KMIOOF~USWE55011IN0115T~r 11. NIITNRACEI9dtM/Mt~Aewt~/) 1. pRTalO~~IM1001MAt/ •~~~wt~r t~I'~T1~E.'1`~~~~~sNnA Blll}.dlll~ ~OY'ldd ~A ll~ek f~t 11 iATMER'S w1rE t~. ~T~A~ Am3rew J. Hall Nellie I. Chason : IS. MAS OECEASEO EtlEA 1M Y. i ARYED i+0wCE5/ tc. socui scwwTr ~a. u~ • a4w?TV~~~ M. Hdll llr..~rrr.d f U/n~.w~ ~ TT~~~~ Cl AO _QOG9 erve n . 1G5 IT~ ji iii~Vi-VJ~iJ ii 1 1Lf i.L' u. ewvss e~ KwrN [~•k...rr.,e ~...r r~? ti.r h t•). ce)..sl c~1.1 ~u.~ . urtuv.~ ~r~r[cu ?n11~ f~ 1 OMSET AMD OEATX air.ese? rMr~ ocwrnwwscwscow- ~lf IT1fliCted ShOt w~0ufld 171 hedd wrEOUTC c~u~c W .~•e r~~• t~• e~r- ti[feat• ~~.1/~~. ~ ~ ~ •1t~ t~• r1~t q 1 • e • 1 ~ ~ ~ , r~sl~tr~r ~qtn/ I~e r~r?• OIIE TO !Ib/ s~~ar lpf. • 1 t A i w 7~ O ~AKf M Q11~1 9GIi1CMf C~OND1i1016 Oa11~IRiwG TO OFAM MR NOi RE4IIO t0 M 7i~~11M1 OIYASE 00~01ftlN GM~1 ~1 M~i 1(~I ' MAS AUTO?51 • _ IOrI• F . /E11i0RMEpD~1 ; t~r d~~t\ ~ ~ 1fE5? MOpJ I or D~N~• r~. 1 tOD. ocsu~ ~aw uuuar oteuR~o. (6~to w.rwr yi~~?r 1~ Prt l r Pw II yire. ~I.) ~ ¦~kl0t ~~1 ~ 11CC10(IR SUK10E MDYKIOE ~ ` ~~•.•i1- ~ p ~ p Self-inflicted shot throu head - enterin at t le ~ .•e~. •r ~ aor 1~riuuRis x.a~. nn. r... ~ ~ 1:02 ~ 11/5/63 = IOf. 1MlIMY OCCU1111E0 ~Ilt. rIACE Oi IwJU11Y i~ v~hor/ ~~t. ~DJ. CITY. TOMN. pl LOCATIOM ODUMTt STATE ~ YMRE AT MOT ~H11.E (~7 1~~. Urtet. ~~a W~I•. dl.) . WO~K ? AT MIOIIK /Y ~ • ~e~.'e St. tucie ~ 21. I~N~nd~d tM d~u~Hd Irom R . to •nd J~~t s~~ ti~~ ~li~~ on DwtA oocvrnd ~f ~D7~X. 1: ~2 P. m on fM d~f~ ~t~Nd ~bw~; ~nd te tA~ ANt o/ m) km~NdN• ~~crn tA~ uuw~ ~f~t~d. E ?11 lt~~s NCMAri11t (Orpa a fY(tl 226 ~OW~ESS ?7t. O~TE SKMED ~ ~ . E. P. DeFriest, J. P. ~2 CAUntV CouY't House 11/7/63 , •lC~f ~t~. ~TpM. 27S p11iE 23r 1UME Oi CEMETEIIY 011 CIIEMATOIIY ~ 23I. LOCATqN (CY/. fNS. M tNaf~) ~g~) . Ft. Pieroe Florida Bur afsP`"~'' 11/8/63 Hillcrest Mem. Gdns. r. s. * ei s t~. ro~c~uu E OA S SIGNATUII~OI N,'^^t~ St • ZS. OATE RECO. ~r LOGL IIfG. RE615TRAR'S SIGNATYRE a...,oss Milton W. Baird Ft. Pieroe Fla. 11/15/63 Anna Lee Denison d.r. ~ ~ • FILEU a~r~ , ~~~~~r ~ ~ r cCu~tDED / ~ ST- lUCtr ~~UN1Y F(~_ /t ~ RuC: ~ . ^:-;~as p ~ o= CLEr..; G~:' COcRT - r,^F' y:. _;c•. ~ ~ Mh~I qff~fi/ ffl~ 10 ~ 1 fYW ~f1d GOfT~CY OOp~/ O'f ~fA 1 L~~` i ~ Repistr~ra noord on ftl~ fn /h~ St. Lud~ County Hishh ~ y ~ = ~ rt,.~,t ~ P;~., F~.~.. l 5i P~! r3 ~ , , ~ _ ^ , ; (Wsmin~: Not valid unl~u ni~ed seal of the St. luci~ ~1 ` ~ . ~ County ~Health Deputment i: •ffix~d.) : ~ ' ~ ~ ~ ~ . . ~ N. M{IIER, AA. D. ~ y Health Officet d loui ~gistnr _ ~ _ ~ . =>,f . ~ /o ~y-73 - . v ~ j' ~ ~ D~p111y LOCAI RlakhA~ ~ ' ~ ~ ~ ~ ~ aouR~ ~ACt 2~~ i"-~„? _ . . _ '"mi - ~ ' ' ~ ~ ~ . , . ~ x.- _