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HomeMy WebLinkAbout1884 - - - - . • - NILLSBOROUGH CUUNTY HEALTN DEPARTMENT ' 1105 E. KENNEDr 8l11D. P,O. B~x l73~ TElE~N4ME 223-1311 ' TAMF~A. FLORIDA 33601 ~ - 2'~4221 ~ - - CERTIFICATE OF DEATH • , (kYrrlwKnl ol Il~~~lti ~nd K~~whi~ONire Cn~krs fTATE FICE NO. IM\I.N?r~~FIM\I111 FLOAtDA ~~~U4~ ~~~~~R~~~ REGI6TRAR•~J NO. =KEASED-N~tlMl ~~~St r~pp~ ~~i~ $E~ DATE Of DEAM ~ ~OMTM, 0~~~ , ROY BARTER WAI.LACE ,Male ,September 17~ 1973 ~~CE ~~R. M~GN. ~~~~K~M ~wOUw, I,O[-~~f~ uuM~ ~.!u uap~~ ~ oo DAIE OF ~IRM ~..Owtw, p~r. COllNT~ Of DEATH ~ r< ~ ancu. ~ ~~~nau :nu~~ ..oi w.~ wows r.~ nu~ ~ Whi te ~ 62 w ~ Ma 31 1911 Hi 11 sborou h CtTV. TOwN. OR lOCA11pN Of pEATM r.swt cm ~r.es rypStlTAI OR OTHER NStRU110N-NMAE ~~r ..pr w t~~w~, crve f~re~ .~e ..wy~~ ~ s?eca, +es o~ .ro ~ Tam a No r~Veterans Administration Hpspital ST~tE QF i~RiM ~o~ ~N u s~, M~re UnIEr+ or ww?r ~pu~nr MAtR1E0. NfVER MARbEO,~ SURVIVRiCs SI~OUSE ~ N r~n. owt ruiotM wre ~ cow»„ wIDOwED. WMORCED ~ sncw. ~ ~ Rrkansas • U.S,A. Married Gertie Bryant ~ - - - - SC~i~~t SECUttt~ ~w(~ER USUAt OCCU?Ai1pN ~G~vt iwo w v.o~i oo..~ pNaa rps~ pr R~p pf ~p~u p~ q,~p~~r ~ ~~M14 ll~~~ ry~N 1~ ~~fi~FO 1 495 32 3112 ~y_~ ~s State of Florida ~E S~O[IVCE-S~4?f COUlPY Illi, iOWN, (~R IOCATION ~NSro~ c~n irm STREET ANO NU+~ER - ~ veu~. .u o~ ..o ~ FLorida ~u S~ Lucie Fort Pierce AIo ,hRoute 4 Sox 425 ~ f~THE~-NAME •~~s~ rroq~ ~.ar MOi11E!-MA1pEH NM~E rws~ r~oa~ us• ~ ~ J~mes Wallace u Dilla Hawks [ ~~~ORM~?Ni-N'u'~f nuMM1G AOORESS ~sn~n w~ r s. Mo , tm w ~ovrr, sr•n, rr~ ~ Mrs Gertie M. Wallace ~n Route 4 Box 425 Fort Pierce Florida 33450 ~ARi 1. pEATM yyAS UUSEO ~Y: (EMEf QN(Y OP~ CAUSf a? nr~ ~u ru I 1~ ~[OuR CaYlt . • WtilIM p«ytt an0 M.M I . s1. ~uc~~ :OUMTY F~A. ' SEPTICEMIA R~~~`" ~"'~~S : . . . ~ »uOV[.K 0 ' . ~ rC~~" , ~ I~~ { +OMD~IIOMS, URINARY TRACT INFECTION ~~cw c..~ ~~sr ro ~ Ib) +.eoure t~uit ~ai. o„e ~o. •s • w»uow..u w ~,~.,,M~ ~~o'.. ee Zg i~IMO C~Yit l~St i BENIGN PROSTATIC HYPERTROPHY ~ P~YT p O1Nf! SIGNNKANT CONDITIONS ca+anws tow~~a~n.w q oe~o. ~w rw~ Murto ~o cws~ e~vew ru~ ~~o~ ~~Y M 1fES ..e~e r~~o~~es ca.~ ~ns o~ i.o~ s~oe~ee n. are¦+wi»e c.~se W Of~TM i _ IA tl~ ~~41 ~CUDiN~. SUiC~Of O! DA ~~T W/ t ~OMTM. p~~, ~H~ 1 MOUR „OW INIURY OCCURRfD ~ e..rn ..•rvn o~ rr,un ~an . o~ ?.n ,rr. rs ~ rC~w:C~DE. O! UNOETE!/~~NED S:ec•hr) i Iw 71~ M 7M ! ~ INJ(1R~' Ai WORIC KALE ~ W~NY ~i MOY~. STtlft, /~Q~t. LOCATIOI'J ~ s~~ier o~ ~.r.e. rq . un o~ io+rM, sr~n ( ~ ~ trlUn RS O~ hOe ~qrK! MOC.l~C ~S?K~n~ ~ ~ ~r ~ ' ~ f ~f~Tif1~A71QN- +OHtr~ D~s ~l~~ +OM~ D~• ?[~t l~Sf yM M4~/NI\ ~~IV! pw 1 OIO/DW MOI v~l~+ ~IN OlA/M OCCUt!!D ~t ew! 1tw(f. Cw fM ; I.~~ i 11M~ • TO ~ rO~M D~~ ~!u ~OOt ~AE~ Of~M :MOU~~ D~~t. ~r~0. ~O ~M! NS~ . 1 0~ rr ~r.ow~foee. oirt ' ,~.~y ;:;;o°:~~Sept. 11, 1973 Sept. 17,1973,,, Se t. 16 73 ~ p , Did Not ,,,2:45a,M ,o,„<<.,,,,,,,,,,.,p CER1ii~Ul~pt~-~nEp~C~I Ea~tr+Ell OR CORO?+ER a.e rwt us~s a r.~e „a,~ or a.n+ , ~~M~ OK~DlMI r~3 ~Mr~pyH(!D Dl~D n...~...~~o.. o• rh~ wv. .ro-o~ r«e ~..res~.~•*,o., ~ti ..r p~..ro.., ..o..n. n.+ .n• ~.ou• ~ '_i.•~ OC(~~Ne Ow m; o~•~ ~eW Du! ~O ~Mt C~vlf:i~ ir~rlo _ ~~1_ M $ ~ CERi~F~Et-wn~+F ,~.e o. ..:»n - - i STiC,trATURE ~ - ow~~F w ~rtii ~TDw?E'S~GNEO ~..o~~. o,...-e:u -UA1'_~~ `~TI~IBINS~ M I~~`__ 4n~ .G` M.D. ~rk Sept. 1 i~ 1973 ~~~iuvG ~;:DRE55-~EFi~frEa s~~~t• o~.~+o MO ~ Q~t O~ IQ~1N y~~n r~~ VetFrans Administration Fios ital 13000 North 30th Street m ~UYIAt. ~REMAT ON, RE+NOVAI fMEiERI' OR CREMAIO~Y-N~~?~f tOCwT10N ~~n p~ row.. ; ~,,;n`~~~R~~OVAL HILLCRFST MF3?iORIAL G DENS. ST. LUCa {*~,S• FT. : _ fV. . _ ' N AN_ _ . . ~ r ~ ? i i~tt. in ~ ~IYL\~~I~T_~ ~ p~Tf ^~hryy~• . ~H ~1 ~`~Y(~t~Af, ~tbM~' ~3~~ no~ ly y i~ 7th St. ~u?~ER~ r.~4.yp- •rurE j .R?ur[ n..rr ~r ~vr° }+_~~.yeee~s~~ ~ 7~ ` ` x1 t . ! . ~ 7. ~~Il~M~a I}{fRFBY C~ RTIFY T}{E ABOVE TO 13E A TRiTF. ANU CnRRECT COPY ~ ~ OF THE TACAL RE:GISTWIR'S RECORD ON FII,F, IN T}IE HIT,i.SROROUGH y`' - ~ - COIINTY HEAGTH D~PARTMENT AT TAMAA FLORIDA WARNTNG: NnT ~ VALIU UNLF,SS RAISEU S~At, OF THE HILI,.SDOROUGH COUNTY iiCAi.TH ~ ' DEPARTh~NT IS AFFI}~F.iTj~ ~ . < 1 _ ~ ~ • ' ' / • ~ - ' f . .C ' ' ! ~ - - ~ . . ~~~2r's:. ~ '1 ~ L _ = - ; "~r~ J~?hh S. Neill ~M.D. ~l~.P.II: )irc~ctr?r ~ - ~,:5`:~.~i ~Cnunty }~ealth~Officer & Local ReRi~~rar ~ _ SE~ ~ ! 1973 C ° ~ ;It ,1;~', r?:~ DfiPUfY RFG ~k o A eoc~ 223 p~c~ ~8~4