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HomeMy WebLinkAbout0045 s. L - ~ 'y~_ - ~ - - _ ~ - M. • - - r. • • ~ r` ,~j,V ~ ~ t~ V - " ~ ~ CERTlFICATE ~OF DEATH ' " ~ Dy.~wN .t Ik.11~ d RaJn6dM.w.e Se..k.. rrwft ?~u Mo. ave~ as ~+sa~n+ F L O R I D A ' t..e. w .e?a x. 479 auutNt~ nwt Rca~sT~w~•• No. ' ~ ~NN ~M w.s+ .+w .•s? sea own a a~m ~ w,+.. n.. ~ ~ ! aswrn»s ~ ~g ~ Septsnbpx 5, 1973 • 4Ct ~w. rN~o. urrcr~ rwK wfit-wr wra ~ n•~ wr~~ DAtE Oi M~M ~~a~. w•. CpMiY d OEwM ! ~ nc. ~wcw~ts 2 ~w~ ~~uu .os. ~.n row~ .r~. '~n",~w • ~,~2 ~3C1@ ~ R1it@ ~ /1 1 A ~ ~'~7 ?a , ~~OL ~ M/M tw tY~ M~NG( ~ Q~i~ii ~~RiiiRA'~ F3+~ i F~. ?Y 2-'i'T. !r Y!!~ : MK~n ~~1 M u0 ~ , ~Ft. Pic+roe Ye$ „ Ft. Pie~me rl~oo~3a1 Hospital _ ~ . iiA1E Oi M!M ~ r Mp r~.~.~., rue p M11Mi C011MitY MMi~EO. NfwEf ~Mt4E0. 510VSE ~ r~nh. Nw r~Nr wr ~ • ~ .~_yf-_~___j_CM~n V~Y\ W~QwFO Q910~G[O~YKn1 . ~ r!W YMhK~ reiu~sy vcu~o ~~arr~,ea N311Btte H3ri~11 ~ .„~':".w, socw secum us~w ocarws~~a~+u.«+:.e.~.... a.o...d.. «.r .o.. « a~+c a ws.+~u a rvuamr r-~w r ~¢~~71 ~T.ir~~ ~ ~'w i q. U~. U~. ~ ~ ; , - ~cswt?~cc-sr.~r cour~+r vn, roww, a~ iounoM ~ w~ ~ ~ i . 101 ~ p~~~,~~ f_~_ V ~ ~ ~ Ib ~i~LjRJO 1+. i4~R:.LC 11~. pLYiJG IN 1~ IM~45 ~ ~ /AT14~~N~~ IMM ~MY Yf~ MOT1rtt-`AMOfN M4~ ~1 ~l YM i ~ 1 q N. 1 IN~O~MM1T-NMrt rA4NG wOWESS ~NMa a~.r.~. wo., M e~ q~. iW. tr~ ' ~ Nanet.ts 8. Deitri,rh „~1145 Bayst~o~e D~ive, Ft. Pi,~x+ce;, Fla. 33450 ; ~~n t otwM wws wrseo ~r. ~rrtN o~r at uust ~ce ~ rd !K Al ~u+o p~ ••••o•~•• ~ , ~ M. . • , ~M O~N~ N.n~ . • ~ I • . ~ ,~~V i ~ ~ 1 ~ cew~.ne.n. w ~w.t ~ y ~ ~ • _ . 1~MM~t~ ~~~H Mn. M . O~ • O+MMK O/: ~ ( ~ ~ w~er~ ~w ~wN? ~ . u~w un f • I 1~ ~ MrtOK~M ~ti ~ n.Nw~/ I M1/ a. QMR SIO?~MCAM QOMOItlpr4f. cw~wn~ ~ a M ..'u w c..n~ «ww r~w ~ r ~ ws e~ ..o~ owN~~ ~an~rrw~ ~ww ; I • d ~w ~ p UOtT~uNlO ~~ow,+. r~. hu ~ NOW WJW~ OCCWlEO ~ e.w~ w~tirr p+uwr r r~n i w~~r w~ ' . ~ ~r~M ~ 1M 7M. M. 7M . ~ MIA7R~ Ai M~'aR N1lR~ ~t rO~M. ~~f~. rK~O~?. ~OCAiION 1 tMA O~ ~.~1. r0-. M~ p q~w. Mw* ~ ~ ~ IiMC~ N~ O~ ~01 OA~O r~..~R. IMKw~ _ . ~ ~ ' CE~frICIJ1ON-~ ~4~1 M~ w~~ ~Ow1~ w t~Y w Wt fn/ Y~ O~ ~ M/M ~ w~~ ~ N~M OCC11M~~ ~t ti Mtf. O+ M . 7M~K/aM: tO tl~~1 Y~ wY ~0~7 N~ ~ ~~Owl w. ~1~. 10 ~M YM ~ 1~n~Mf~ 1~! ~ /~b~ s~ W~Y~G. M . 1N Ku.f~~ ho. iM. 7N t11 fM. K t0 ~t wnew wx~. ~ L ' CEritKat~On- E~~~ME. a..r ~.s~s er .~t - .ow a . - Mcx~.. w ~.aew.a~ wu ; , ~t~~w0~~ O~ ~~W~ Y~/p IM ~MS~IO~wOn, r~1 0~~4. r0~~ M1 ~W MOA M~~ 00[~M/~ d~ r YA M~ ~M b~ tYMW W~M. ; CE~tYIE!- mw a~ rr.e K o~ O~~a+r. M•. n.~ ~ ~ ~ . n. A~fred J. Cornills Y. D. n. MARN6 ~OWESS-OffiE~ uwn w~.r.~. w. ww - n. ~ ~ i WwMtN~q,r ~dE~rN~1~O~M. ~ErOrAI iEn O~ GErV~iOnl-N~ME ~ l on a ow wn ~ ~ ~y tv~~VSl a~~ H~.tA[1 MHtYJ~3~31 '~.~1• H~t+al CQ111 ~1Y1. ~ ~ ~ . ,6, M• 3 ~ ,s~tu ~-~L Q~: 901 iN. 7 ~ .St « pFt. ~P'~ierce Flaricia 33450 1 i. ~b 12 ~ - / .~tc?s -LC++~rwt w uu~ren n ~ow ua~uw ~ •.~.:o~o ,w ~Q. + ,w. t~er 7 1973 r h.~.by owtify thk to a~ . tn,. .nd oorr~ct oopy of ths t~oc.~ , Re~isrrar: noord on fit~ In th~ St. tud~ Count~? l~.~hh Drp~A- , . - mrrit at FoA Pieru, Florid~. • (YVemin~: Not yaJid unl~ss nised seal of the St. Luci~ , Cou~ry Health Dep~rtment i: ~ffix~d.) ~ ~ _ - - N. 0. MILLER, M. D. ~ ' ~ Fisalth Offitat d~ loul eg(strar I J ~ r r - ~ ;,J.i~; , DN~ OMx+h toul Reai~~?~r 69J ~ F,~EO Arc RECORoE~ ~ ~ - ST. WC1~ COUMTr FU. !l, RO~~~ ~ ~?iA~S ~J CLERK ~ :LII COURT RFC~F~ ~':='`:EO.~....~.~.. NoW 19 9 39-bH'Z3-- - eocr:~2~._~a~i