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HomeMy WebLinkAbout1195 ~ _ , [ Vr„~,~..r~ _ _ . . _ CERTIFICATE OF DEATH ~ • ~rf~ewl ~ 1~~1~ ~nd Reb~bi~ll~tl~e $et~kes fTATE fIL[ NO. ~ . i~~~xrv c~ ~rwi.ni F L O R I D A lY?E. O~ ?[IN1 IN ~'~~~^'~R•w"~ REG16TI1Aq"~S NO. 7~ ~tIMAN[NT INK ~EwSED-M~JM[ ~NS~ roeu us~ ~x OwiE OF OE~TM ~ •o«iw, e.., •t.~ ~ ~ 7EE ~MIOOI 101 ~s~~ , - DFNZII, E. Iff.TRZC3c : Male , F 17 1974 66~,1 t~Ct .r~m. M~OW. ~W~K~M MOYM. AGE-411 wa~ r n.~ u.on ~ w. OwTf Of ~Mn~ ~.w»rw. w•. COUnt? O~ OFwTn ~u. ~ sncr. ~ w~nr•~ ~.~•~s~ .o~. wn ~owf .w. •u~ ~ ~ i~fifte w 73 ~ k ~ St. Iucie . tm, ~owN, cx tourqN p o[~ ..sw ca..r.s MOS/IiAI O~ O1ME~ NSTITtR -NAMf ~M wp~ ul liM~. GM St~ ~ ue r~y~y[t 1 s?tca~ ,.s w «o Ft. Piero~ Yes Ft. Pierae Memri.al Hospital S1ATE O~ M!M ir ro~ r~ ~.s a.. Muu p1uE?~ pi wNAi ~011Hi~11 wultpED, t+EVE~ W~tbEO. SI~Vry~'K~t S~OUSE ~p OM W~M WW 1 cow»., ~ wippy+E~~o ~ wcn ~ ' uwu asw..tt ~ ~C~all ~ ~Mkl Mdl'~CJc'~1@~ ~V18 +.ra eec~~~te u~ns. r a.r SOOAI SfCWrtr M1WEe USU~t OCCU?ATqn ~w~rt .w a.w~ ewr wwa ros? a KNO Of NlSIrrESS O~ l~OYSitt " „ 372-22-8531 ,~-7M, MM u ~tMN 1 Aan Farni ~rinM~d. 6M L~a~~.1.~ ~tYOtMC~ NM! ~srauow. ~ESIDENCE-SfAtE COUNi~ Uri, TOwN. Of IOUT~ON ~f~ cwr ira STtEEt ~MD 1~UM~E Flarida St. Lucie Ft. Pieroe ""`"Yes ~w ~w u~ ~a 317 N. 12t.$ St. IAT1Ef-NAMf ~Nyl rbq~ uS~ MOT11f~-MAIDfH N4AIE ~~yr r:eot! uf~ „ ~Y Hetriak Rabina Finley f'] I WpRMAHt-MnMf wulM1(; wDOfE15 ~snnr p~ ~.r.a. .q . cm w w~», suq, tr~ ~h Ma~'9aret Fietrick ,n 317 N. 12th St., Fk. Pireroe~ Flo~'fc7~i 33450 1. OEAM WAS CAUSED ~r~ (ENTEf ONIY Qfrt Gll/SE I(! lMrt FOR (e~ /bJ, A!p (e urw~~w n+ ~~ru . ~ H \~ir1lM OMS~~ ~MO Ol~tM ~V1~ . 1.1 /4GL~.G COtOKQ4 ~LtOM1~10~fA. cri ~ ~o....,.o».. H~ctui.oac,GP.to~i.a fua~c.t di.ae.a~ - ~rKw p.~~ ns~ w I f ~~~fOl~t~ CAVSI IOr, j ~ ro. d~S ~ COwSlOVtK~ b: ~ u l1~~~M0 iM~ VNOf~- + ~,j \IIMO C~Yl~ l~l~ 1 b ute.sa' Ib ute.ztioK ~ 0T11F! ~IGNIFICANI ~p~qITIpNS; ca.~na+s cawa~rn.q q et.n. aur ..or eeun~ ro c~vu Gm~ w~u~ . w~ AU1011Y rt YES .e~e n~ou.as ca.- p.~,td~~ ~ ns o. ~ ra~es a~e~..~.wo c.vu or et~rM ~pNo~ N`o - MOM 16(~ Ot U~t[WWEO A tiOMM. Y~, 17~~1 NOUR MOW INH/~Y OCCUR~E~ ~~++~H wqrw p~rwfr u~ r~7 ~ W Nn n, qr ~ 1M Ik M IY INIUR+I wi wOtK HwtE OF NJU~~ ~o.e. .u... ~reen. r.c~o~.. IOC~nOr+ ~ ~ snen o~ wo., un o~ rmrn. s~•w ~ ~ ~ sm.~. ns w..o ~ ow.ce wec .~K . yecr. ~ U. 7M 11~ ~ CE~f~iK/~T~ON- ..w~+ wr .~u ra.n. w. •w us~ s~. w..i.o •im o« ~ wiao w~ +r. «e otw o.~ nn ra.ce. o.. wr IM~fKUH: tO ~ rpn~M M~ AY Wp~ AIry~ Ol~M, ~ ~IIt~r0f0 tw~ J } ~MOIM~~~~JJ~~~ ~~R. ~~+0. q M Mit fl~ M[l~HD ~~0~ I'~~ ll~ fl~ w. ~ b~Q•~ ~4 !L OiKIQC/w ~O Mf U1~q~~r~ . CE~TIFKw~~Or~-aEOK~t Ei~~Ell Of COItp+E~: a+ rwe ua.s a nK wo.~ u a.w n.e srcree.n ..s ,+o-~ow+cro wu ~~...v.•no.. w ne we. .u.e/o~ n~e .nes~w•*c». w.. w..w.~. ..o~.~¦ w~ .eu .our x•rw acvuw or. re we ...s we ~o wia urt~n~ s.•as ~ r» l CE~i IER-NAME ~rm w r~..n SIGNA M. ~ ~i wcn~ rme DA SIW~f~ ~.a.n~. w•,.eu~ n. . B oodui,n M D - 2-I9-7~ ,"y"'~g.'~p'1E54``aCt~J~'S7 I17 N. s{/`i"~~' P~i~.ict La , t/. R ~G Al. CtEMAr10N. ~fMOVAt f1NEtfKY Ot ClEMAtOitr-N~?~( tOCAT10H ~ an W t0~... sr.t~ ,w~~ir~ovdl-&lrial FOre3t H(I[!e CHri~ ~ r« Irii , O~tE ~rpww, w~, nu~ fl1HERAl NQME-NAME INp AppffSi smn w~.r s ro., cm p~ ro.+., fur~, hr ~ Feb. 19 1974 r,. ~~~.9Q1 N. 7th St. , Ft. Pi,eroe, Florida 33450 Y• ~b 12 f -SK~~A/K ~ ISTRAR-SIGN.1fW[ D~i! ~ ClrvtO t7 ltXwl ~E ~ nA! ' R.~.1970 ,A ,M J, ~eb. 19, I~~/4 fllit~ • : .'t'"O~f£0 : ~:i~is~ 3.A• 1 h~nby awtify thit to b~ e hw ~.~d cornet oopy of fh~ trocelST. ~vJ __,•--.f3 ~i ~ ti.•'~:1~~3i(;; fil in St. ~iuck C.oun Fl~sl1h rt. ~ ; _ t T y~ ~ ~ . - Rpistr~/~ reoord w+ e th~ fY ~P~ C~ ~ . r.,~ ,~~-"~j'c m~nt ~t ~ort Pi~rce, florida. ~c ^ r:• . _ - - ' ~ ; - _ . (yysrni~g: Not v'slid~unless raised ieal of th~ St. Luc~ p ~~?1, ~ r_ r-' County lioahh Depertment is effix~d.) ~i~ y-' 1_- . v : N. D. MIIIER, AA. z~s~~~~~ `/'~J~~r~,1110~ Co~+ty 'H~slth Off+ur 6 Loal Rpish~ . ~ ~,~i~ ? f ,11:5 -,~.a~: - . . p~~ t,oul Rroistrs? ~ ~ 2~~4 FA~E ~.~.94 . ; _ _ . ~ _ _ . -