HomeMy WebLinkAbout1816 ~ - - - - ~ i_
CERTIFICATE OF DEATH ,2~,A.
(kpartwent of lk~it6 and R~ba6ili~aHve $er~k~e~ /'TAtE FIL6 NO. ~
IM\'tVOtY OF IM:~I.lil F L O R I D A
rr?E. OR fRINT IN "'~"°~""'~^"'~^O REGI6TNAR•S NO.
?ItMANINT ~NK E~EASEp-?r ruit , r~p t! • i~st ~x ~AIE Of DEAM ~ ~oNtw, o~r, ~tu ~
A
scE ~o~oo~ ~ae 1~~ 4 4 EDNARD N.
"~'"'~10~ ~ t- BROaN : Male , December 7. 19?3 'L~
RACE ~~n. ..eGW. ~rencw ~wouN, AGE-ust ~+t~e u..oe~ ~ o.r OA~E Of NRM ~nw~rw, p~~. COUNi1f pf OEAM
ia. ~ s?ecnr i ~nwy' ~ re~~ai ~ros. w~s ~.o~a rr~. J81~1 • 8~ 1906 ~Oi~I31'(~ ~
~ i~'hite b r
CRY, TOWN. OR IOCAT1pN Of pEATN Ms~w un u..~n rqS~1TAl OR OTHfR NST~TUTION-wAME ~ u.q~ u~ e~~rq~, cro srre~ .w ~ a
snca. .es o¦ ..o ~ '
~ n Hollyti+ood Yes Mersorial Hospital ~ ' ~
SfAfE OF pRTN i u wot ~ u.s.... ..ar~ CIRZFN Of WHAT COUNTRT MARRIEO. NEVER MAI[R~EO. SURViV~K, S/OUSE ~~r rnt. pnt .ubb+ wu.t ~ p r rn
Indiana U S. A.
usu.i .esa.~u cowta. ~ • • i~ ~
~.a'rr~ed ~ ~ Helen Holl ~ c ~
r11~M ~~~~k0 • _ ,
uvFO. v o~•n~ SOCUI SECUR~T~r NUMlE2 USUwI OCCU?ATqN iwrt awo or woaa oa+e ow~.w .wsr a KwC Of WSwESS OR wOUSTRT _
Otcu~tlC w ~rOtiwG uM. MM p Mn~fO ~ 1
3??-10-6119 Custorlian school Eoard ~ U
.es:oe»u wwn
•cr~isqr~. RESIDENCE-SIAfE COUMY CITT, TOWN, OR IOCATION M~ Cm iwrt! SttEET /WD NU~lER ~
Florida Broxard Holl ood D~ i
~w ~y ~w yK ~~~~n T10 ~~~,39 Sutton Rom~ p~'r"-°m
FATHER-NAME r~nt rwa! us~ MOTHER-AUfpEN NUNf nn~ a,ooit u! '
~s John Braxn Ida 'LBu h
INIORAU?NT-NAME MAIWG AOGRESS ~ ~sreeer p~ e.r.o. ..o. c~n u ro.r.., sr•n, ir~
tfrs. Helen Brokn ~n 9 Sutton Roa.d Ho21 ooc~ Flori a
~ ~ItlT 1, p[ATM W11S GIUSfD 0~: 1fNTFR ONl7 ON[ CAUSE IER LWE fOR (o). (A). ANO (c)J .rrrou+.w e.•~
:i :.wa:.~e c.c:t - ~~n+ti~ ors~~ •no ~a.rr
< ~~~..~clz a.~~ L~.ccc~ ~ ~ a -
~ . ~ N ~
I
COMOIiIOMS~ 1/ ~M~ ~t ~
~ rw~t» G~v! ui! i0 (e) ' a,,,. ~
; ~rr[O~w?t C~Yf[ ~m. ~ ~O, W ~f ~ tONl! .K[ O~: /
! fI~11N6 tw! YMOEt-
i \fIN6 CwY1! ~~St ` D~ w n
f lcl Qsf~ T~!/L ~(K'C CL~iZ~~(i(,((Z4fQ ~1L[J~
~ART N. OTHER SIGNIfKANT ~ONp1TIpN5: cowanws cow ..c p u.n~ wr.wr a„ano ro uvu e ?ui ~ w~ nUT S~ ~ES wen n..o~wcs cor~-
ITlS O~ MO~ LOt~tO ~N O[:(~WMIMG GaVft
o~ oe.~~
Yes
~.~bo~1~~ wCUDEHT, SVKiDE OR DA Wl ~ ra+rM, w~, n~~ ~ MOUR MOW INIURT OCCURRED ~ e~te~ wnnt o~ ~.uun u. r•~r ~ o~ r~n m.. ~
IIOM~CJO~: OR UNDEtEtM~NED ~
~ M ta - ~ M. ter
' IH1t1R11 AT WORK ?IACE OF M1URY ~t nore. r~~r. Srun, r.aw., IOC~TION ~ s~nn w c~.o. ..o.. un o~ iow.., st.a ~
! ~ar[an rts o~ .w~ prsrp roa.tu. +situn~
7M 1~1 !0~
: CERT1fKAT~ON- ..wrw w. ~w ..o..m o., ~w uro au a..r wwiwn •u•t o.~ ~ ao o~o ~.Ot ~ tMt OEwTN OCCUtlfO mt ruce. ~
' ~NTSKI~N: TO ~~M WT t[~t ~pp~ ((~'DFZFM IwpVfl O~R, aMO. p ST
~ ~~ne..oeo r~e ~ L I 7 1 2N 12 / 1- or r• c..o~vuocr ov~
; l4 o[custo ~w. 7 7 197 :i, iu n12:1
ro rwe cwuse~ ai.*to.
j CERTIFICA~fON-a~fO~Cwt fx/u+UNER OR CORO?~ER o.~ rwe us~s p rne ~ove or a•m *Me oeceotN~ v~s r~o.~pu.~c~o oe.o yy
~ lurw~tWM W M qOr ~~.D/O~ M! wr(StK.~rp~a, w rY Ww~W~+, rOwiN O~t ~l~.~ wOY~
~ Ol~TM OtCVl~fD Or~ 1Mt O~~! ua0 OY[ 10 Tw! C~uSl1S1 Sl~tfD. ~
~ n. ~ m
CERTIFIrR-~.~ mn O~ rewn SK,NA Ma~et o~ nnt O~TE SIGr~ED ~~w.M, o.,,rt~~
~ r~. VDiIJ~C-_~ S. ~CSo ~Y~ r~. ~~rP-a~u K~- ~~L w
MALLING ADORESS-CERiiFrfR ST~Ff~ O~ ~ t D r.o c~n o~ so.+.. sr~?e
ri 3329 Johnson 5treet Hollviro Florida 02~
a ~UttAl. QEMATIpN, tfMpVAt CFMETERT OR CREMAiORY-NAA4f tOCAf10N t~t? q qwn sTwTe
~ ~ sMC~/r ~ .
~ z.. Burial n?Holl kood A'emorial Gdns. r.~ Holl ond Florid~--
i OATE ~ rpNir, o~t, R~~ ~ iUNERAI HOME-NAME ANO ADDRESS it~tlt ~~J O w0 , Ctt~ Oe (QMM, 37~i~, jl? 1
; Dece~ber Z0~ 1 ~ ~intter Kirb ChapelsT, .~107 I~:ir~:r~ar` Pkxy. , r.iramar, Fla. 3302
e Ss /612 FUNER~ I I L~ I i~ 4 V" L~ Rf S/ ~
Q J ~ R A R- S i G
N A i U R ~ ~ D A i! C E ~ Y E D ~ t i C C~ I t f G~ T- t
~ Rev. 1q70 ts~ i~ ~ ~M - r ~ 1~_ , tw r .
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CERTIFIED COP'Y ; ; ~ . 7
c~ - ~
I hereby certify the above to be a true and correct copy of the Local
Registrar's record on file in the Broward County~Health Department at
Fort Lauderdale, Florida. ~ o ~
t . ~ J=
¢ ~
-~(1l1arni,Ag:. , Not valid un].ess raised seal of the Broward County Health ~
i ~ . ' ~~~Department is aff' e~,) ~
~ : , . - - - h;
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County Health Offi er and Local ke~istrar N
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, . a~a~ 223 P~cf~~1.
Deputy L al Kegistrar . ~