Loading...
HomeMy WebLinkAbout1763 _ . - - ~ 1'' sace so.ra or K~.iw 2?72G~TIFICATE OF DEATH sc.c. gua xo.___-- J surcau ot viw 8tae~.au F L O S I D A RegLttar'~ Na • f 1. PLACS OF DSJITH: UBUAL RE61p~tCi Or DiCfG6Wi ~ ' !a) CwstY. ~ - ~ ' ^~'trk~ N r, ' ' r =I r . , • • , . (b1 1`retl~et ~ Iirelne! Ne ta) St~ta . _ (D) Carnt> ~ ~ lWr/t~ we». ~el awnDsr/ ~ . • _ 1r. V! (el Ciqx^., - • Clp x ~ r.~ le) Clyr ~r Tow~ ~ TOr.~ 7b~rA N0. K ~ I I~ O~tsN~ t!!J K t0~10 lloltl~ 1?ilU AUJtAl.l v (d) ~taar et Mrpiltl er Iwtltnlba` ` • . ' ! ~ • ld) &~wt I`q ~ O ti! wl la Iwrpl{~1 et IqUWtlab wrlq ~trMt wmber or locauw~ (tt tirai. ~Iw baWal 1.~a~tY ~f ~l i: ^ Clllsee of T~fNSp loWllr7t r Y ~7~ ~V~lal ~t Is~Utotlow wl yLc~ of dNt\ ^ - - - - - ~ . 7M ~r w~ ![~aNh ~AHlwr ~r~?n. a~eatlu or ~~Y~l T~ 3'~+. saw ea~ntq i) v - Z /1 ~ / - b lVt.t. NA1[S OY' DRCI`i.AOBD ' ~ " ~ ~ ~ ~ s(s) u r~c..~o. . i[w socL! eK.r~V• . ,~ixa~cw4 cKlcr~ncwr~ox 3 ^ i. w~aw .wr Na r :0. D~u.or I~e~th: Nwth p;sr . ~ i ~ . i 8r: ' CoNr ~e eao~ f! ' Year i~_ Aa~t Iilorta ]r. • - 3t. I M~epy cvrtlt~ tMt I ~t4wd~~ lp~ ~rcwsw (roen ~ . . slue~w rn.R~ee. .wo..a or af.waw • ' ' { IL ~u??rlN. ~No~'N eR QvotcN. 1lusbaM o[ (w1 / . , 1f: ~ lb r - r : ls . ~ . . : A tL~t 1 4ul ww b.:~ - _ alhn ae ~ - _ 10 ~ s ~ wll~ ~t , ( ' ~ i • • - u~ tMt death aturM eR,tM 4b waa ~iwr N~tM R4en. Ilrr~tM~ f ~ ibl A~ et A~r6aM er ~U~. it lllw . % r . , r..ra , . . ' ' • ~ . • , lmwldlab qYM ~I i~at\ ~ ' ' ' _ 1 7. 1prlA 4~b e[ la~a~~e1 -).!i f _ . . (wmUU tAaJ) lYear) • , wi+: IMe~ . ~[a~t1r . D~A If Iw thu~ ou~ ~ar uw ls %'1 ~ - ~ ' / //7 bn. mle. Dw to ! 0. tclrta0lan - i . . • ~ . ~ (MMr ~~owAllfoM I~ t/[Cltr. towo oc twst~) : (Btat~ x[ere?sn ew~t ) (I~e1We y~aeqr ~rIt6U ~ ww11u ot de~lU) ~ 10. Uawl ectopqlia~ _ ' . . ..s ~1"'" . -i ll_ ~1dtUth' M b11~~4lY ' >I4MM /UWlet~: t p • . / ~'r e/ OWI11~41~ (jM~fl1{/If - ^ ~ ~i. ~iIM - - l'rt~f ~ ' 4 ~ N'`~ ~lr~ tJ. itirtAp4rr ' ~1 t61r4uNaprsUau) MA•~li ~e c ~ tt )Idaee warr» ~ • ~ • : , ~ ,t~ . , ot .rtoppr ~~d'~ . ~l 1.: AIrtAPtaee ~ It daNti~ ~ws ~w ts ubnal cauw. tU! Iq tIr lolMal~= J0. Istormaat'~ dip~t~tr _ _ ~ - .t ' _ ' (j'reb?Wr) AKid:q4 pklN. Aan1tIM (speeity) i f6 (a) Addrw ~ ~ - • (bl Dats ot oeearrwe~ . • fe) NAS?~ ~W inlar~ ott~r! • 1T. IIarlal. wemado~ or rseoo~a!! - . lC~t~ or lown) (COaqty) IAIw~H 1? (al l~ate ll (D) 1'I~ce - <dl Dtd in)nry occtir Iw ~r ~bot Aaae. os I~rm, le IMrivtai vlaav, to ( is. tbn~r.1 n~.eecor. el~ar. , • rus+le pl.oel " . t~c1ry t~y~ ot piace) , ' is (t) Aidreq , ~ ' • ' R'6ik at serk j , ' Nea~~ 41r4 _ ~ ~ 1!. T1W T`10 Y'~~ - ' . ~ . ' - 23. Sl~awn. - - • ~4 D. I.out RetUtrar W AdAceia p~y g~~~{ ' ' - . ~ hu,~by artNy thh fo b~ s nw and eornet oopY of th~ Loeal Rspistnrs ?sootd on ~k in th~ St• Lutit Cou^ty H~aith O~paA- ANnt ~t Fo~t Pi~ra~, flortds. . ; : - !u~ ~ (VYerning: Not v~lid uinless raised seal of th~ St. Gounty Hqaith Department is affized.) •`r ~~~~I~rd~O~~.'~`~~~~_ ~ F, . . : . - r a - . y ~ - • " . ~ r ''„~•r- ~~s... ~s- , i N. D. MIIIER, M. D. ,t: ; 6 s 'i ~-5 '~I ~ € Cpmty 1irRh Offiur a Looal Rpittru t~r~. s_;~,'~` ~ = • ,.r t ~ f;,, . ; - t ~ • . , s ~;~y ,t'~ ~ t ~ - ~ r . ~ . C ~ s 1~1 - - . . / ,c. . ~o, :~'~s .s,~ x~` _~c~ ~ ~ , ~ pM,~ L~ul R~oisnK ~ ~ ~ a 0 . . . . ; ~ jn i ' i~L~ _ i ' ' 3 ~ i k F ~ . ~ , _ " ' . F S l p~~~r ` ~ll~~lll.af ~0 . • ? Le;ibility of writing, tYPing f LE~ aEC~R0E0 i~.lUCt~ +:oUNTY fLA. ' nr ~arinting unsatigfactor~ in R~~E=. ~orTRAS [~t ' :.~is document for microiilming• CLER!c C~: "uIf COttRt P,~CG?~ '~EF =t~4 ` .~Ail ~ ~0 S5 ~'1~ ~ bLUI. ~'At ? ~.7~ • ? 720'~2 ~ ~