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HomeMy WebLinkAbout2281 ~ / CERTIFiCATE OF DEATH 2'~441~3 ~ av~s~aH ~~.,~.ReL.TMY~w.. S...ioe. sTwn nti.s No. F n.~. o. .n~ a+ •~••••••a•••~•,•~ F L O R I D A N[dIST11A11•• No. Mt~A1/M? IMI~ ~A~_k,yME n~sr riea~ u~tt SH ~~OOI f0~ SEX DATE Of OfA1M ~ rO~rw, e~t, ~eu ~ ~ •s~~s ~ ArD~7W F. (,R~ONIl~I :MaLe , December 31 1973 ( RACE rrwn, wtaw. u~etKUa ~NONM, AGf-u~f~ uwt~ ~*u~ woe~ ~ wr OATE OF ~IRIH ~nowN, s?~. COUNTr Of DfATM ~ ac ~ vecvi ~ w~n~s~~ nus~ ..os. o.n «wea •uu ~ , White 6~ . . Jtit~e 6 1907 Indian River 0(~. CrtY. TOWN. O! IOCATlON OF DEAIit ..sre c~n urns HOSMTAI Ot OMER NSTITliT10N- ~r +ar emwa. cnt sr~en .vo Nuwe~ i r ueur. +es w .a ~ Vero Bea,~ Yes H Inc;ian River Men~ial ital STATE Of W1M i a Mo~ N+ u. s~.. .~..~e unzei of wrur tow+ntr M/tRRIFO. NEYER MARNED. StltVIV11iG S~pUSE ~ r~rw. oert w~oew w~re ~ ' ^~.w~opwQ vo~ : NeW J ~ (7SA 1~7a]CY01 ~eu o~~~~•• ~ AC~d S13YI~P..r uw.~ niiawce • ~ i f q ieU 1~. .~e?e oecuseo SOCULL SfCWITY M1+wfR USUM OCCWAt10N ~onre ar+~ or vwa oo~e owuw rofi oi llreo I Ol~IM KM~ ~ W.s~u ~~1~t~r 13S-05-9174 ~`Pre's ~~~clent~~- F+oun~er . ~°ry•~p.. Precisi,an Rep~roc~ucti~ons Inc .~uot..ce ueo~e I • ,o.~ss~o.. RESIpENCE-SiAtf GOUNfIf CR11. TOWN. Ot IOCATION ~sw t~n ?w~ts SiREET ANO NUM~ER ~~~v~ Florida ~ ~•`N, St. Iiucie - Ft. Pie,rce No Rt. 2 Boot 2766 fwTMER-N~,ME nni ' r~oou uu MOTMER-AtADEN NM~E ~r~ rwai uu IS a'aliiiClM 1' . ~~1 _ U ~ LQil pBEr~. ~ WOMMNT-NM~E wulWG ~DDRESS ~snEer o~ ~ ~ o. wo . cmr o~ w,r,., a~.n, :r~ Ac~a Cronin ,n Rt. 2, Booc 2766, Ft. P3eroe, Flo~~da 33450 /~RT 1. OEA1M WAS CAUSEO ~1f: ~fNif~ ONII' ONf GUSE IfR /Iif fOR (a~ fbJ, u~D k)1 ~e~ ~ee.. oKaa~ .w a~a ~ w+touR 4ws! ~ . - . . ~_f4~ ~ I ~ G f=~• ~ I-f c~~ ti ~~t~ ; . . ~ : , ~~/j~ - toM~~uoMS n •w?. l .L ~ ~rT /a"t. ~ rrKr O~vl~ u~! q (e) CV~ ~ ~ ~ ~7 1 ~ ' - ~r..tawre ear~e ~a, ~ ~ a ~ w eo..uouo+ce a: - s~.uKO iMe YMO~b • ~nNO c•uu ult ` ~'~t-~=ruSC LJy i!~ ~ i ~~I~GSc ~~11~ i:1 ~AR1 M Oi?~t ~~1[ANT COf/01T1ONS: CO~~I~Or~t COwMMwO q Y[~lw r eqwreo ro u~u om.. r. ?~n i a~ ~~r M rEi rr~n ~~NO~ as eo~r ~ . ~ns a w~ f~eteeo ~N a~ee.uNUw twN t n 01 OtAiN JL C-~? ' / .J ~w ~1~o~1~,1 wClJOE?~t ~iOEIOR A ~ra~~w, we, nu~ MOW IMJU~1 OCCURREO ~ errt~ wtwt o~ ~wwtv ~w r.u ~ w rut n, ww ~ 6E, O! tllO~IEtWNEb ~:«+M 7M Mt M NI INIURY AT WORK /IACE Of MIURY.~ wr. r•u, swn. ~~non, tOG?110N ~ snin w u.o. .~o.. cm oe w.na, s~~+e ~ ~ snun ~es o~ ..o i ornee rne , tu ~ snear i !M 2tl ~ ~ CERfIfKwT10N- ~w w. rw ra.w~ w. uo uf~ sww ww/¦n .u+a a+ ~ w~ow .~o~ vxa me oe~M OCCUUEO ~i me n~c[, a. wr ~M~SKIwN: 1 TO rd~M O~? ttY wor ~rtt~ w~m. iwouu Wq. ~MO. q M! MW . ~~newOtO ~wt / 7 J ~ 2 7~ _ 1 tl~. II~ ~ p r? [r~t106l. OM l?~ D~Cf~1fD ~~OM 21~ 11c 2•~ PM ~o ny uvs~~s~ ~u~. CERtMKwT10N-~EDKAt E R OR COlONEI: w nu w+a p n~e .ar~ o~ a.m rw[ oecroa.r ru noMOw.ceo oewa turrut~p. d n! qOr ~w/ iwe wvlStiWtqw. w r~ d~W~+, rOntM O~t rtw~ MOW ' OfwM p(G1N~lO OM ~M O~tt MW pY! M M~ CI.Yfl1i1 ff~f(o • tt~ M. ~ , CEtt ER-?+M~ ~nn .w+r oeeue w mt A SIC,NEO ~..o.+n., wr. ~w~ ,H ~ur~1~ S - ~-pE~AAR~ ~~t4~ - titwkM~G ~OD~fSS-~E~ttf[t ~ s~~ett w~ r.o. .~o. ~ e~n w..e si.n :r ~k C T~ L S C, L~ N~ c C-~.t~ 5 C-~1-t 2(o ~Ut1Al. CREMATION. ~EMOVwt fA1ETEtY OR ClfMATORY-HM~tf IOCAiION un q~ov„~ sun ~~•K~`~ ial. H. Hillcrest Mem. Gardens Ft. Piesce Flo~r3da _ ~ Di?TE-~ i..owiw,w~,rw~ F~~~- '~,9b~"N: ~~1th,•~S`t:«••»:,••P'`Les+ce, FLo~ida 33450 ,+r`~~~l 3 . S. ~612 _r~~~j ~ -s+ra+~ru~ ~eonnwa R~v.1910 ~'l r' L~~ ~ ~ ~ . a "I hereby certify the above to he a true and correct copy of the 2oca1 registrar~s record on fiZe in the Indian Ri.ver County Nealth Depattment at Vero T3each, Florida ~ This is not valid unless the raised seal of the Indian lZiver Cvunty Hea1;,~,~;~D,epartment is affixed. ~ _ '~~~1li1't ` ,~f~~ti1;i. { - '1; ~11~! . FIIEC •'.h•_ ~=~?:iDEO • C'~ . • ~ . ~ , r,. - ST.IUC;E .:OUNTY FLA. J ~ , RU~4~ 'J:Tr~AS ' s)•'~ , ~t C1Ef~!! .:,;!'7 COURT, _ f(• q~„~~,, County HeaZth Dir. Loca2 Reg. ~ 1 S/ , ,''f(% : ; - . . ~ ' ' ` ~ ~ fEa 11 i oz PM'1 ~02 ' Y'''~ Deputy ~ gistrar j.:Ifi , ~ ' . Z'L ~ ~ t r ~ 223 P~~C~M~~/~