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HomeMy WebLinkAbout1045 i4 6~~~iJ`~ ~ ~ ' ---r - - . _ -~.r _ - - ~ CERTlF1CATE 4F DEA?'H . QrpA~eN ~ I1e~11{~ ~wa Re~billl~lf~e Serke~ lTAT[ FILt NO. a~~s+on cx ~~a~.n~ F L O R I D A i'ttf, O! !liNt ua w~.~~rwerw..wo NE61tT11A11•! Ho. F44 HlMANtNi IMK ~EA~_N~ rNS~ ••yp< <~t~ SEX owTt a oc~n~ ~•oMrw, e.~. ~~u~ . SEE YMI00~ 10f •s~~ I3.^.:N'~'TT ~tiGL~c:.'~`t :::ale , November 23 1973 U1CE rwn~. rtow, u.encu~ weur. wGE-ut~ v.oe~ ~•~u r..et~ ~ w~ OATE Oi WM ~.~0~. ~a~. COYH11f q OEAM ex. ~ wcr~ ~ w+w~•. ~.e.~s~ .ws wn wu~s +w ~ . :fi.ite 70 w k t June 1~' 190 Saint Lucie ~ e,? Crtv. tOwN. Ot IOGiW?~ W OE~M ..rre cw. i..n~ „OS?rt~l OR OTHEt ~+S~rtIN~- ~ r.o~ a. eme~, o/w sr~ee~ w.wri~ ~ y?1CM1 hl W MO : ert Pierce :'es „ .^,::t~ - :~ort Pierce ?~:Emorial Hospital n SiATE O~ NRM ~ r wot w~ r~~.. ~+~r~ pTZEH Of vmu1T C01MT~~ wutMED. ?~EVEt W?tLEO. SUl~IIV~K+ S~OUSE t r.~w. ow~ r?«.. w~rt ~ toww~ ~ vnOOwEO. ONOKEC vecn ~ ~7 • vswa~lWfKt ~ rtC~V Yor'.c • ~J : N :~~ar~ie S 11. ~Zlldr@U ..r.'.ZklnS r+~etl Mcafe~ SOCIAI SEd1~TY i~AMNE! USU~I OCCU?ATION ~6ne iw M rwa oon~ ewrq rost M KMO Of ~USl1ES5 O~ MMnI1STh1 U1Ip. Y N~M «s~..a~n *'e~~ister C131'i: ,~,,,~„u~,,,, „ 07G-36-543~ U. S. Post Office .swsw~+. RESIOENCE-sl~tE eOUHt1f Grt1l. iOwN. OR IOGrWN ws~e cw ir~s SttHt ANO ?NJ~~E . ~ ~ vec~n m a w tM r1C1r1dc"? 1•5t• I~UC1C~ I~t. St• 1~UC?C IN +es ~Ml~ r:axanja ~ATMfR-NAME ~~~ft r~0a~ up MOTMEf-A4DEN NM~E r~e3t rNae uN „ Jac~b ;~n~? eman So~I~iey~ :viener ::.:..;;,:a.:_..,,,.~ . - - - • n. ::ildred En~ler~an v,10~• `:~_ranja Pt..St. Luci.e Florida 33452 run ~ .u ou?n~ wwf CwusEO ~r: ~IHrE~ axr or+E Gus[ rER lr+[ rot N). (6L kM ~ w,..... o«.a+.... «.o. q. w . / , i ~c'.-~ ~ s~ c. E%c~~" • is a~ !e ~ ee~.~ ~ M . CONO~t~OM~~ ~I ~M~ - ow~Cw 0~~~ Of~ q ( IrntM~lt (~Y!! 101, { MM /0. W~3 ~ CO~+S~OMK! p. St~tIMO 1,1f ¦M~~~- I _ ~nMO C~Yff l~N (t~ ~~Ri OinEt SK,t~~fK~wi CO?~D~t~p+S= ca.wnwa ca+avn..e ~o eun. w~ ..o~ nuns w uw a~n« r r.n . w~ ~~Y ~ ~ES ~en r~.in..os ea+- ~ns o~ .a~ s~a~e~ ~M MreuuMewo ewu M et~~w ~ A 1~ 11~ MpOrK~Ot: OR~OEtE~Mw D w . ra.~w, w~, re•~ ~ MOllf MOW IN1UlY OLCUtlED ~ a.m~ wMt W n.rrn ~•n ~ q?.n n, we. ~I ~ ~ ~ 70 1~k M 1Y 3 IN11Nr AT WO~R HACE Of N1Ut+? .wa. s.rn. r.c~w+. IOCATION ~ smn o~ .w., cm w~o.ru, tr~R ~ " 1fMC~A ~1t W M0/ p1K! U~G..lK. 1lMCM~~ i ~ M ~ f ~ CEUTiKJ~T~O~+- .o..n. w~ au ~ .a.~ ea. ~eu u~o u~f~ L~r wr/r!~ ~lM OM . er/o.e w~ ~ w~ otwrn oCNU[o ae n~n. w wr 4 ~MtSK1AN: rP~M Wf ~!Y ~Or~ ~nl~ Ol~11~. IwOV~I O~R. ~i0. q M Nff ~~RtM0t0 /w! TO ~ L Q p rr ~wryMlOG. OW ~ fN wcus~o rw~ 6 2 7 ~7U 11 2 !l. 11 2 tl~ did tb p i 2~ r~ ?o ~we uwunr sr.ao. CERiYKwT~ON-r~ED~G?! ExAMM~ff Ot COROnEt. a. r.~ ~.HS w m[ wo~ p ee.wi ~we Neew.n .u ~+o..auace~ au l~Y~M~nOr' p IM q0~ ~K/W M w~~)iW/OM. ~n d~~. N~' MOV~ p Of~A OCCWMO OM M W~! ~~M OY~ b TM! UYY~S~ St~,lO m M 1!~ ~ M. ~ CE~Tfw t-NAMf n.re o~ r~.n SiGNwiUK ~ ee w r OAiE SH3r~ED ~.o~a., wr,,w~ Jl.t-i~l. 1`l• -L ~ . 7k ~ ~ ~~Dima Vista Blvd'•e'«Port St. Lucie« Florida ~ ~ Wf1Al. CREMAT~ON. ~fMOVwI GEMETfRn OR CtEMATOt1r-a~F IOGT~ON u~ a io.r.. u.*~ ~ ~ frKY~ ~ Burial eth ~1 `:er:.ori :1 Par'c ,w Fort Pierce, Florida ~ DATE ~.Ortw. M~, R.~ ~ fUNERAI MOME-NAME ANO AOpREiS' ~ tu!!~ M~ r.~. wp., C~n p~ ~0~, fui~. f~~ 1 e x,•n~,. ~S ]~73 n.~'~tes ~ u_^.~?-~i. ?`o~e nox 777 Ft: Pierce :'2 334~0 own aeewco ~ow aaisrw v. 5. ~612 ?N~+EW S~GN~l~r ~EG~ wR-SrGNwrutE/~ ~ R~r. 1970 ~ c2C/~ • '.`.L_ ta /1 - dC . ~ tw. "OVC~~~..~PT' 2f+ ~973 ~ " - = fQED ANO RfCORp~~ ~ 1 her+sby asrtify thk to b~ s trw ~~d aorrsct copy of ths loca~ ST. UiC1E COIIMTr .fu Ro~Ea ao~sa,?s , 4~a Re~istrars reo~rd on fil~ U t!~ St. l,ucl~ County H~shfi D~pwt- ~~~RK CI :CUiT COtIRT ~ ~ m~nt st fort Pierc~, fbrfd~. REC~ttO v~RtFSEC~i1 . , "n ^ , _ ~ ' i (Warning: Not valid unlsss rsised seat of the St. luci~ n f t~~`~~,~H~~~l~~d~~~'=;,~~~• Counry Health Department is affixed.) 'Y 1~ ~ ~ f a~t~~. yr ~ ; ~r . . s N. MIIIER, M. D. ~ , • • ~ : x = . ` ~;1 y Health Officer b lotal istr~r 2694,~ t- ' _ J - ~ ~ . . - ~3; . ,i~ . o _3: s ~ >~~v~`~~ 3 C~ . ~ ~ ~?~~~dlil~3.•S ~ Q~1~ - Dsputy LOUI Reoian,~r 1:1~~ . ~ . , . ~ ~ B~~~c ~2~ F':1~~f <-~;h - ~ _ . _ = _