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HomeMy WebLinkAbout0455 . ' - 1. ~ CERTIFICATE OF DEATH l+ / '~~522~ ~ i ~ep~rtiweal oI 11c+~tb ~wd Re1~aLilllalive 1etrlces ~TATE FIL! NO. ~ iH~~ww ~w ur_~~.~~~ t j. ~ R l r! M ~ *~rF, O! ?~iwf tH K"'tl'~'R"~`^""' REGISTRAR•8 NO. fi~Mf""~NT INK - Sff MJlUlJOR FO! aEGEwSEO-NNwf nqt rwou u» ~x 9ATE 01 CEATM ~ rOMM, O~r, •t~~ 1 ' ~~R~o~ , Vera P. Peeling , Female August 6, 1973 ~ , RACE vrwq. ..taw. •rtnc•w ...ouw, AGE-i•st ~~M~ r n.~ ~.o~a ~ e•• OATE Of i1RTM ~ror.rr, oar. COUNTIf Of OfItTN ~ - liC. 1 VlCM~ / ~~~twi~~ ~~t~lll rpf. D~~1 MOY~S rM. 1 . White 55 k ~Sept. 13, 1917„~ Br~wazd Cf(Y, TQwN, QR tOUTIpN pf pEwTM ws~o~ em u..~n 1pSMAl OR OTHER f~Si11U11pN-NA+~F ~u ..o~ ~N enwe~, e~+e sru~~ •.~p ~ ~ ~ ! ~ I _ 3?tCVf /t1 p~ MO n Plantation Yes Plantation General Hospital - STATE Of NRM ~ u wo~ ~w ~.a.. ,~+~re CITI2EN Of W?1A1 COUNiR11 MARR?EO, NEVER MARdED. SURVIVNG 51011SE ~ h rue, a'rt w~otN wwt ~ tow+m ~ Wi00WE0. pIVQRCED ~ s?~trr ~ ~,~,<lENOfw(~ ~ Ohio U.S,A. N Married »r:,~ „«.St, n. Donald P. Peeling ..eo oe,~ti IOCU? SECURi11i ?~uWER USUwI OCCi»aT~Or.: ~u•e .wo o~ .ro~a oo..e ouu..~, roi~ or KWp pf q~SwESS Ot INDUSTRv ^:c~e~to ~y wo~i.wa wt, rv~w u eeu~tfl i ,t 292-22-9069 ~f~J4 Seamstress Boating ~ '-"-"'O" RES~DENCE-StAiE COUNTII CiTli, TOWN, OR IOCATION wsroe tm irrti STRfEi AND NLWf! 1~.~. ~ sr[c~n ~es w «o ~ ~ : ~Florida ~w Broward ,k Fort Lauderdale w No 6010 N. E. 2nd.Avenue fwTnER-nnMf r,ni rwou usr MOtMER-i?u~Dfn Nww~E rru ..,owe usr , ~s Ira Butts ;~aura L. ~o:.-ney INfORw~NI-rrwMf MAftWG AppRESS ~sruer o~ ~.r_o. ~.o. cm w ~o~+, sr.tt. tu~ v. Mr. Donald P. Peelin ~n 6010 N. E. 2nd Ave., Ft. Lauderdale, Fla. ~ ....a..k.« : fART 1. DEwTM WwS UUSEO Q~: ;~rtiEt :,t.tr ~rC ~~tL~S: :FR ::::c FO. ~o;. iu/. ~»u ~c~j senreu. oMSe~ .wo vt~rw ~ 1~. wr[oun c•we ~ („(?l/ V ~ ~ t-c91tiL ~ •l~3.1 ; ~.~Tco..uou~ e cowo~nora, u ..n, ~ - vrwicM G.rI ust to (bl ~ i~ IYrlD~~f! (~VS! lol, p~ ~Q. « ~1 ~ [OMStC{I[MCt M' ~ sr~unp twt uaoe~- LtINp (~yl~ ~~11 ' ' f/UT N. OT?fER SK,f~~flCwNi CONDIt1~5: cwano..s eorermu+~./e ro oe.rw ~u~ .w~ aEUno ~o uuse e~rt.. u. r.er ~ m~ /Wt0~5~ If 1E5 ..eee nr.o~«es epa IR3 U HO~ 1~pt~f0 ~w O!fl~r~.~~hG CAyf! ' or ou~w ~ h'o I t?~oboWtl ACU6Er:T, SUiCiD£ DATE :NlU1t1l ~rp.Tw. en~, ~t+~i lIOUR MOW INIURT OCCURREO ~~Mt~ .a.nr~t O~ ~»iun ~M nn .O~ r•n n, ~rw 1lOM?GDF: O[ U++OEtEtl~~nfD ' ~bl ~ 70c M !N ~ ...wv.•...ror r.rcKr...ow . ' ~f?K11t 01 MOI ~I/Kl NDG.,lK. ~y~Kln1 - ' ' ' - ' ! ~a ~ ! tfRTlftCwi~Otr- ..o~.cw w• ri•a ..o~+n~ o.. re.~ uro u.s. s..v ~wi~c~ .u~rt a+ ~ oro/o~0 ~Gt rq~v nu O(~iM OGCUl~ED .r rwr . ucr. o•~ nrr ~NtSK1AN: tO ra.m a~r nu soo+ .~n~ w.m o~Te, .~o. .o o.[ usr ~ rnFwDlb twt ~ ~~72, ~ T O~ r~ i.~p~rtFOG(, pv! 21~ D[UNEO «O~ ~ ~tu Alle~ . 6~ 19~ 3 ti~ ~~r'" S 1 r 7) ~u '1~J': t~~8 ~ 55a M*o r~e e.~u~a~ s•.~FO. ~ ~ CERTR1U1iION-MEDKAL EJ[AMtNER ~R CCRONER-. o.. rw~ ~as~s O~ Mt .qw p~ a.~„ tME OFCtOt'li w~S HpHpy~ED DF~D f. ![e.rw~Tqs~ 01 M! ~OD~ Ar.O/O~ tM W~ISiK.~~.~w, :w rt plaa~pq. ~1paT D~t rl~~ MOY¦ ~ Dl~M p~~4flf9 On Mt D~T! ~MD DU! W tM[ C~VStI)1 ST~~FD s ~c":_ 7T~ M 7 ' LERi1fIFR-NAaiE mn o~ .n..n - SIGN u M~ c[wee r~r,~? ~D~TE 51 0 ~ r~c.•,.w~ ~ Dr. Arthur I. Sec~aul MD rn f'Gv ~tk ~ ~ MIALLNKs ADDRfS$-CFi:1ffEA s~+etT o+ r.s,a «o. .n p. r~.;, ~ ix 4330 W. 8roward Slvd. ,:`ort La~t~derdale, ld~'ida~ z" : ~URIAL, CREMATION, RFMOVAI CEMETERY OR CREMAiORY~NAME ~O~AIIpN ~ Cm O~ pwr~ s:wTE / S?lUn ~ ~ • 2~. Removal :W Memorial Park Cemetery ,k Montgomery County, Ohio i° ~ OA~f Irpi7M, O~I, T~~f1 fUNfRAi 1iOME-NA.wf AND ApOtf55 ~ Sr~e[t O~ !.r O. w0., [n~ O~ tOwv, sute, i~? ~ ~y Au . 8 1973 n. Kalis Funeral Home 25 L'. ~ixie Hr~., Ft. Lauderdale, Fla, ° Kov. 2~70 F~~` ~~~~-y~~iURf - " -~I~ltAiUR ow ~fC[i~'ED IOCAI ~tG111t j 9 tA 4 • 1. ~ ?M ~ 7~ . . • C~;RT~FIF;D COPY . j '~52~~? . : I liereby certify the rzho~~e to be a true uz~d corz•ect copy of tr.e Local ; ` Iiegiatrzr's i•ecord on file in thc 13roward County. Jiealth Departcent u~ 'nT ' ~ Fort I,audcrdale, t'lorida. , ` ~ • ~ w:~ • - . . ' - a = , ' - r • ` ~ o'~m ` (Nar '~E~! yr~` ~Y~ n - ' ~ ~ ~ ~Q - , .;g. f...~ Q {id unle~s r~~io..d real of the Broward County ~fealth ''~~m~~= ; . , ~ - - , ~~~a~cp4~~,la+~T1t ic affixed.) Q~ 4- i . . i 1! ~ C~ c~,~ T~ ' Cy • ~ t, . . ._y ~ ~ , + • ~ .O~'^ ']-+~-~c-~c~ ~ f ~-,.;.p .•nt i - . ~ ~ . . ~ ~ ~ w c . . ~ . . ~'3 % / .,~j! '~f~..~' ~ ~ ~ -t , , ~ . . ; - ~Cl~tti r' . i`, ~ ~ - ~ s : v . • ?t. !A ~;:•~,~i~~ ~ : ~ County }irz~ltt~ Of; icc:' ~nci l.ocal ilc~i ~tr~~rr ~.r ~ ' - "~-r~_._.T~~~a 31L~::'_,~ ' ~ ~ ~ ~ ~ ^~^.r~~' . (~/..~i~ ~~ii n,~ ~ • _ • TA~ . • . . w V ~ ~ ~l ~,L~ 'rt ~r~ --7-~3 ~ . _ , ~ ~ U t-:.~ ~G, , . _ _ ~ PAt~ ; ' . DcpuLy I.vc~l jcej;~cti•ar _ - ~ ~ _ ~ _ , _ ~ ;