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SOUTH BEND, INDIANA
~ THIS IS TO CERTIFY, thut our records show:
Name .HA_ZEL..B....~RGER_...........----
died _.Qc~Qb~x..----...~.7.,--_-_~.964.._.. at ~O:O~A._Mat _~St...Jos~ph...FioSP~.ta~,~"~~haxaka.--•-•
. moatL day Yocr ~out strwt, aospital w ruial
Age at death ....._6_9._. . Sex - .~em3].e..._ Color .---...i~h.i..t~ .............M~'ried---
y~°t~ mariied, sinql~ or othec
Primary cuuse of death given was..___ Carcinoma,. o~,_~iver________________ _ '
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Certified by --Richard..A..._Schaphorst,..I~!I:D• ..............................•Misha~aka, _.Indiana
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Addrass
Place of burial or zemoval 5~.....sIQ~TI' ~._~e.~~t~~cy...--•--• ---------•----------,T~oodla~}d,..Indiana.
Gm~tery Addcets
2U,--1969..._ ..,~l~b..i~~n~ra]...Ch~ap~l--- -------------Ma.sha~,Talsa., -.Ind:L.~a
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x~o a_~?~ ~~a;. -~.Oc~ob~.~r..22_,...~6Q--~------ Book .?1..R1?. 6
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Q - St. Ioseph Countp Health OEficer
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z•.,~,.~ i;~.".c1~~,,.r' , Issued on ----.--..._---------.October._28,__19.---~0-
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. Re: Lot 50, Block 16, PORT CHARLOTTE SUBDIVISION,
Section 2; and Lot 6, Block 796, PORT CHAR-
LOTTE SUBDIVISION, Section 27, according to
' the Plats thereof recorded in the Public Re-
cords of Charlotte County, Florida.
Re: Lot 30, B1ock 115, PORT ST. LUCIE, Section 27,
a Subdivision according to the Plat thereof re-
corded in Plat Book 14, Page 5, of the Public
Records of St. Lucie County, Florida.
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