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HomeMy WebLinkAbout1910 - ~ • - ~ ---J - _ , - ~ ~ CERTlF1CATE OF DEATH DepA~ew1 ~1 Ile~lt~ ~wd ReL~6ilp~li~e $enln+ fTATt FLLR NO. - M~•~~~¢w~.»~ FLORIDA tY?E, O! IRINi IN ~~'~'Oi~~"~'O pE61iTNAR•s NO. F71 ~ H~MANtNi INK ~~~p_H~ rqst ~wu ~.s~ ~Y OATE W DEAM ero»~w, ~ss, n~~~ SEf M~~CI00[ i01 "s~1016 ~ G:~/,::'~LZ\'.: Jv'; ,S 4Ii.L~ emalc , :'ove^~ber 2;i 1973 RACE .+M+e. r~ow..wncu. r.ww. ~GE-u:r w+ee• ~.eu w~w~ ~ w• OwTE Of ~lan~ ~.o.nw. w~. COlN1Tr Of OEwM ~K. 1 1MC1I71 WIMO~~ 1 tt~1~f 1 r0f. M~! Md1~/ rM. ~lA~ 1 t•lhite 76 „ k ebol0 lt'~7 ~~int Lucie ~]st72 CITr. TOMM. O! LOCAT~ON Of OE~M wa~w e~ ~..m aOStiTwt OR OTMEt lKirt ION- ~w .o~ em~e~. w~n sneer ~w .we~ ~ > s.eer. .n w .w ; ort Piercc 1'cs _i3 ~ Souti: Seventh Street STATE Of WM 1 M NO~ M Y.! NW! UtIZB~ O~ WlIA1 COIM~nf MAtf~EO. NEK! w~RbFO. SNtvIVNG SPONSf ~r wt. o+.r ~?sw w+r i CONI~ 1 ~V~~ ~.HIC/~ 1 . ~ :.ales ~ US:~ N .v~~o;•r~~c. „ we~e ~ec+.u~ SOCut SECUetr t~NY4E~ USUA1 OCCUTATION ~o~n tw W rpa 00~1 W~wO rott Or uw v K~r KIHp Of ~1iS~+ESS O~ wDUSieT oecw~es r ~r ~O un. Nt.. r~lmN ~ n ~l?~ . ~f. P.e~ist~xec ::ursc :~:edicine ~lMOtK~ ~tq~f ~ws~+• IiESqENCE- t~tE COlIN111 C7I11. TOMM. Ot IOCAi10N ws~w cn ~rwf STtfET ANO !KlM~E! ~ ~l~KN1 f~~ a M~ ~k"lorida ~N St. Lucie ~k ~ort ~ ierce Ycs „535 SoufF~ ~th S 4rce ~ /ATNEl~NAME ~pl~ ryq! u3t rMOTNER-MAbFH NAMf ~1tft ~qpf Wi „ Cvan E:enr• J~n~s rl~ z~heth Conibear ~~MO~Mw+~-NAME ~Rr+G w00eESS isnn~ w~.r e..a.. cm a ro.+«. si•n. tr~ Ldi.th .7. Sr.2it~~ ~n 5~:~ 7tn ~t. rt. Piercc : 1 33450 ~ .~.r ` OEAM WAS CAUSED iY: ~EdTEf W~KY O?~f UUSf IER l/+E fOt hl AL 4ND (in ~~n.uw w+ui .w ~e~Tw ~ 1~. wrlM~R U11f~ . ~ ~ I ~ ~o«..ao~~, `1 ~ ' rw~tM O~~! ~~f~ ~O ~ h~ Ir~~M~i! C~Yf! 1M. ~ ro. ~S ~ COwtlOUlKt d: ~ 11~fIM0 fM! YM~lF l~IMO C~tlf~ ?•sr ~ ~~1 A. ~T SKi?~~fK~NT CON01i~ON5: co..MO MM1f~~wG 10 p~IM N~ ~+0~ MYq~ f0 C~V 4 w M?ul I ql A~aSY ~f Yfs 1r~~f ~IMYIMOt COM- ~ ~t/f O~ Nyl~ f1O~~~0 IM qryWMIMd Gyu n J p ~~~1N ~ IA r If1 I~qMKq[, Ol~{?O~1EWNtO A 1~OMM. M~, •w ~ NpW 1 U OCCU~tEO ~ tr~e~ wrw q~wivn ~r rut ~ O~ ~•n q m. ~ ~ ~M 1M. M. N! . IN~lR/ AT M~ORR 11wCE OF nlUtv.~ ~wr. s,~en. r.e~o~.. ?OCwTWa 134t0 M~J.~. MO.. GR O~ tO~w, lt~q 1 , t tIlCln 1f! O~ Ilp I pMl[f ~1Cp.. 1 yKN~ 1 ~ ~ ~ ~(R'I/SCAT101'1- tli~M M~ . tl~a rpwM M~ ~W ~w0 ~wl~ Lti w~/W~ u1~! ON 1 /WO ~O~ ~K~ M! O[ATM OCGYf!!O HM ~4[t. Oti M! IN~SICNIN: TO wO~~nl Mr RY WO~ M1l~ Ol~1w. ~ ~1 wn. u.s. w wn ~ear , .m~... June ~965 ;~ov. 26 73 ~:ov 20 ?3 : 3oP ~.b.,.~.. tt~ aa~us ~?o.. 1~? tt~ tu M. ro nu e.vsen~ srarco. • r~ CERTIfKwT10N-ME6Ult EX/1M1NEe Ot GORONEt~ 0.1 ~w us~a o~ ne +w~ o. w.m rw~ eecwe.n rn r~orou~+ce~ oew eu..r..na. a n.i ws. ..oio~ n~ .n~snw.ow. a. r, o~wa... r~w~w w~ .ae wow Yt~~w OC(W~lY Or~ M! YR ~MO 011! 10 M 4Vfl41 S~~RO. ~ th M ~ tb q CftTIH. t-?{yNf ~me w rrwa S T wwei d nn~ OATE ~w..n~, •..w~ 71i j~.l~-. ikatkins b~.D. a' ~/-2 ~ ~ MAIIrrG ~S~-CEft//EIX f~ p~ ~ r .a cm ro... s~.n r ty DV 39?6 Fort ~~erce, rlorida WRtAI. QEMAiION. ~MOVAI fMEiEf~f OR UEwMTORY-NM~E IOCAT~ON c~n w w.~ sun i s~et++~ ,M Crer~atior. '~t, Pierce 4re~atori ?ort Piezce, Florida D~iE i..o~+~r. ~.r, n.~~ filraERwl HOME-tiwiwF ~riD SS i s~nn o~ ~.r.e. .w.. cm w w n. tnl ,N „~Yates F'unera~::o-.e, inc e~ L'ox c t. Pi.erce ~ rl 33aS0 Y. S~ ~b 12 ~ REGIS R-SiGHATUff OnQ tKa+tO ~i IOCy Itit~ ~~v.197o tA / ~ ' H. ~ *Y.~Ce~!'i~E?z' 1~73 FIL"[C A':!'_!~LvuRC~D }~~y orrtify thu ro b~ e trw ~nd corr~ oopy of th~ Locei ST.IUC?*. _~J~NTY Fl~~ Rpls~rars record o~ file in th~ St•~lucie Counry H~sith Dopert- Q~;~_ :~~-Re5 ~ RNnt ~~t FoA Pi~rce. Florida. ~lF ~ u~~ CUURT L ar^~y;._.. _ _ (Ws~ning: Not vs~id`unless ra~sed sea! of th~ St. Luci~ ' ~ ~ Counry HP~hh Deperrment is affix~d.) 7 ~ ' ~ FEB ~ 1 ~ 57 AK T~ . N. D. MiIIER. M. D. 2~`~f.~..~~3 ~ y'H~Ith Off~ur 3 I,ocs istr~r la•~-~3 ~ - ~ pr~, D~puty loul Rraistror - ; ~ " 223 ~~cE 1910 z~~.~