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HomeMy WebLinkAbout2440 a~ r-- . - - - - - _ ~r . ~ _ CERTlFiCfi.Tc OF DEATti Dc{r(~+e+t ~ I Ir.1tL auA l~~l..l.::~~.~i+e ~rn:cr~ QiA: E Fiti 1:0. ~w••:a,•~~? FLORIDA ~f ~ i~?i. O\ /I~NT Ih ~"'~'~~~^'~w•^^"~ REGISTAAR•S ItiO. L~1? s ~iIIMANiNT INK ~ fU W~l'v01 IOt ~fCf~UED-aAME ~•nt .+aa~~ ..sr .S[t ~OwtE GF DEw7n ~•owir, ~i•~~ t ; ~rssr~crwn , IgF.~ L. JQ~ :F~.~le Anril 8, 1973 L1CE rw1/. w~Oq. ~~a~Kw Nrw. AGC- ~I oe~ r•t.~ '.,.ce~ . a.. t DnTE OF ~:+:M ..o+rw. Nr, ~ . uc. ~ vur~ ~ I r~r~ . ~w ~CDu?+T'I Of DE~t~ . , ~.i.~s~r`.aa wn . .o..~~ r, . ~ite ~1 : { ~Oct. 8, 1911 i,. St. Li:cie ^ ~iY. TOW?i. O~ lOCwi~ON DEATN ~ ~~•o~ cur .~..n tipu.TA: O: G~NEI NST~TySrOfJ-NwME ~r .qr uw•. cne araar w„re~ ~ 6002 F't. Piez+Ce • ~ ~ r Yes F`~. Pierce N~ial P.aspital _ SiwTf Oi W/M ~w ror .r r.~.~., ww GTiZfN Of Wnwi CJ1.trT~Y ~Mwt::F~. K[vE~ w~ittfD. SWVN~IC Sip~i( ~r rr~. o~r~ r.~wr ..y ~ COywm ~ .r.~t R. vA O. Wtr~ ~ ~~%kY USA i,~"°I~~rYic~" Wi.lliam H. Jaztes ~ .,~n Nu.us ~ - .rv~~. «•r lOCW SECuUIY lFIWf! uSU~. OCCur~:~J.~ .cn~ .~a o. wo.a ow awrw .~w~ a KwD Oi WSwfSS Ot WOWTtr ~ •OCCYWP w ~Oru~i. /v~.w n Ii ~e.l I ~ ~ •I~~~1~i ~ -y.;;~ Np:; „401-07-6658 ~~y K.~ ri3lcer , aro.. , rs~ c.n .~w~ ~Si~EFi AMO NHWEI ~ES.DEn~E-sr.t7E COW+ri G7r. TO'M+. Ot ~OCwT~ : ~w Flarida St.Iucie Ft. Pi~ca i,=.~ ~~I~o• Rt. 4, Eo~c 320 ~ /AT/1[~~NAM[ I~q1 r..1DN uN ~ M~iAti~AM1.7iN M~A~f ~.q1 ~.N.~ ~y} ~ ~ ? ~i FYOC; G~3T~~ H8~t,1@ ~tYCW r ~ ~NIOLi+~t+T-+.iw[ ;tiawK r.; wAG~:SS .u•e~~ n~.~.~...o. e.er w ro.., ~e.n. ir~ ~ William H. Jones ~.4,: ~ax 320, Ft. Pi~erce, Florid~ 33450 ~ .?ART 1. OEAM WwS CMlSfD ~Y. •ENiit O~++t~ CM~E CwLSE ~fi ~wE i0i !~1 l?~ AHO (~17 o.~.s~~ •••~o a.+. 1~ ~~tN4 4rN / f ~ ~~i Y i .a . .o.~.~.....:i o.: ~ o ~ ' j h ~%.,o.~.o... " .o t.: ~.u..r~ w . ys~ ~m. ~w w. a .s . co:.u ~.:.-w ~ ir.u.:~ ~ r~u• ' : a , . < ~ ~~~~s-~C~.~ t ' ; r •4 //Y ~ IwtT r. OTKE~ ~^tyJ~C.wi COr+~D.TWtiS:~ w.a~..ria ca«.~~~i.~ ro a..u~ wi n..! O io t.ua a.n.. +..u~ ~ w~ +wUidSY ~~F rE1 rt•~ ....~,,.cs c0«~ . ~ / .n~ a «o~ : s~euw xi~~...~.w~ c~usr . )r- ~ ~ w ~u~. .-,,-.~wrl- -KCr~tw - -q:~OE W `Owl . f tM NC ' ~n . N.?~r.GUF: Ot uWalaWU+tD ~~!r..4tY . a.., n.~ MOW ~NiulY OCCUtlED u.~u ww~ W~wwo u. i.~t ~ w r.~t aar u. ~ original injury i '~__~2-20-6S Y ~r. fell broke left hip ' ~ ~wa+tr',at wOat r.,~e~ or w~uer...~o.e.'• ..c.o.r, : ~6C..:.Qv ~ ar.~~t a ..o.. un a ~o... s..u ~ • u~acu. .u w.a~ iw.a~ ww .~u. ~ wac.n ~ j . ILO ~.yi ;:Y, . ~ CFiIYK~i.ON- ~w.+. w• n.~ ' ..o~.:. o.. •tu ~~wG u~fT Yv wr/+1\ Y~H O~ M/P4 r01 vMM /MI Of~TM OCCY\~lD w..K~. o. o-. . /h11/C1~N: . +a•1~ O~'I ttV ~0~~ Yil~ N~4. ~IwOY~I Y~~~. ~r.p. :O .lN ~tii •n~wi~O ~~l ~^~OlL ~ ,70`~~1 . A1 Y rI inO~JOGl. DN S'.• O~CU1~D ~~0~ V8(_=-- a 4-5-73 4-7-73 not ~ TO n.~ 4.x:U ix.t~a CEiiv+:wT~pi~-w~[D~Cwi Et~vwwE~ Qi COi.',n.ER. o. a•s.a or sr „p~~ p.•x.~„ - r..~ wt~ct..~ ~•s nowo~..u~ M.1 . ~ ~..~o..e~o+ 01 or .w. .w~e. .r ....~u.e.e,;,.,. w..w~.. ~ .o..:. a., , ~..u. otew.eo w w o+r~ a w~ a~r u.ua~ v~ne. ~ e r.. ~~j :n A 1~1 8 1973 4_4j A` ' ~ ~f~ry~. . CdTti.fi-~+.WE mn o ~.n , ~ / / q`~1e O_ _ :D~~`.•-_ _ J+ i r~. ohn B Sulliv n Y~` ' -L_ --l--- S ~ VL D. : r:~ - ~ ~ r ~ 3~ / / ~ ~ e+w~:w4 ~DD ~~i~ a. o~~ n w w+w ae.n t ~ ~H ~I~6~`~ '`~th St. Ft. Pierce Fla. 33~~U ~ !l.lt~w1. C¢EMATqN, lEMpVµ CEl?tiEtr Ot Cif~nw:pt7-.M1SwtF ~~OCwT~On t~*r W qw+ S~.ta E ~~~j,,~,,~^, n.~.,. pYt~.Y T~,.~~,~~ ,A ~ 7a. ~Y`W~1~~"` ~ ~ 7~~ +'~/-.-rq~een 4Ci.ic~ ~ N< iJlJla.a.~v~1G ~T:~~ ~ ; ~ ~ °ytAoril ~~l`g`1'.~••~ ~f~lhEi~ FL:~2PsL~~C15~~901~~\:~`~t~i~'~t ~~~:°~ie.r~Q~ Fl~"' 33450 ' Y. S. ~612 ~ rE O!> wE ~ ~tG~S R-5/'vn4:Wc,~y~ wrt uiuv[o .oC.~ aaus:au ; R~r. 297G ~t-~~"~~i~ • . ::.s. 7~ 'L 7 ~ )u. ~~T`li ~ l7 ~Q73 . s T f € f1LE0 Gh~ h~~~~~E~ ' 1 he~+ebY e~tifY thb to bs e trv~ ud eorr+~ct 57.lUCiE~~OUNR~SLA. o~~'y Of 1f~e LDC'ol RG ~E ; Ragisha~s reoord on file tn th~ $t. Lucb CouMy Koshh p~tf. CLERK C~?r UiT Cat1RT • j ~ ~ meni at Fiort Pieroe, Florlda. aF!:CR~ vE~lrtED ~ (Waming• Not valid unisss nised ~oei of fha St. LtxlO 13 t0 05 AM ~~~`~~~f " : Coun1Y tfeehh Department Is afftx~da ~ . ~ ~,s >t °t~ ~ stt_. ~w ~+~f " ` } . ~ .f ~t k ~~t~~:~~ r . . ` . M~u~ ~ Q ~ * . Q ~P'~f- -L ? ' ~ .1' . ~ I ' . ~ !lerltb Offi~ ls p~lsirar ~j y - ; <j ' i ; ai„ .A• i i ' 1, ! • - _ ~ . • - ~ - /S/-7 3 • ~ ~ .'-%;:~n::; { , LY,~~~< ` ~ Di~i{y L00~ ~Fst}"~j ' , ~.'u~ -.i~ ° • ' r - ~ _ ~ t r,~. . _ ~ _ . l ?~•h~ } f ~ 'i i ~ ` ~UOK ~~Q FAGF2436 - . , ~ _ ~