HomeMy WebLinkAbout1919 ti I~J~ 8~1
IN RE: PROPERTY IN NE 1/4 of SE 1/4, Section 9, Township 35 South,
Range 40 East, as described in deed recorde~? in O. R. Book
224, at page 242, public records of St. Lucie County,
Florida.
C..:..~TIFICH
~ E OF DEAI H
t!~ F L O R I D A **wTe FILi No.
REGISTRAR•8 NO. I y 3_ _
:BIRTH .NO_
y 1.
ACE OF DEATH coo~ Ho. ~ L USUAL RESIQENCE ~w~... eR...a u..a tt a.u~.w.: n~~~. wrK.
COUNiY I STATE CAUNTY ru~w~m~.
~ st~ z„ • ' b(~_~ Flori.da St._ Lucie_
b. CITY tu w~ul.f~ e«aww l~~~u. ~dw nl:iul.f c. lEN6TH OF ^ e. GTY lIt wt~W~ aww~~u wtu. ~NU RUi~W
STAY lu uu~ W~w~ I OR
~ ~ TOWH ~t 9i Prr~+, I A Y7'~S~ ' 70WN F}.. P~@Y'CA
~ d. W ll NAME OF llf rt la lo~IW ~t leNltuUae, ~th ~tcMl Wdrw ~r ke~tloal ij d. STIEET lu nnl 1~utw~
~ ~ HOS?ITAIOt ~ ADDtESS 1 - -
~ ~ INSiliUT10N 1 e , ! $~;Q~Ati~- _
~ ~ 7. NAME OF a. (tl'nt D. lSfiddls) e. IIa~t) DATE (KontD) 1D~7) lYar)
~ ~ DECEASED ~ _ OF 7
~~t (TVn~ or Priwt) ~ '~LLt2~ E'- DEATM J+ZIy ~l -19~ 3
S. SEX ~.COL RO RA (7. MANRIED,NEYE1tMARRIED, DATE OF {ItiH , 1.A6E~~~ ~M vun~~+i.~ ~r. ~a~~~•.~
J WIDOWED, DIVOACEO ~~.at~) ~ f W~ s~neAO) y~~ Do~,H~.n L~
~ ~ . ~ ~ T~D.~r. 1 _19~3 ~ ~ ~ ~
IOa. USUAL OCCU~AilON;O~.~ kt.d ~t .arr ~Ob- KINO OF tUSINESS OR IN• ' il. /IRTN?UCE ~euu ~r t.e.~n ~«wen~ 1!. CITIZEN OF WMAT
w' dsw drNet oat H~xllat Utw u ntindl DUSTRY I COUHi~Y)
h , ~ ~ ? us~?-
Q~~ ' Il. ATHE NAME ; 1~. 1dOTHEt'S MAIDEN NAME
i ~s ~ !
p r~ m . c~y~~ o ,~dt~e r r~ ~
p G ~;IS.
WAS
DECEASEO~YERI~A~~D FOACES7 I1~. SOCIAI SECURITY V. INFORMAHTS 516NATUtE j;ilton t~~ • BA~i C~
~ p. h lYa. m. ~r reteo.~l ~tt s«. rn or ~r e~u~ ~t an~~ i NO. AD~lE55 ' ti -
?
p~^ - -
W,~ f~ u. CAUSE OF DEATH MEDICAI. GERTIFtCAT10N `~NTCwvw~ ~cTwccH
OMaR AND D~ATN
Q~ Enter onb on~ uwe OISEASE OR CONDITION ~
~ ~ yer lia~ [or DItECTLY IEADIN6 TO OEATH•(+i
and (e)
~ ~ ~ ~ ANTEGEDENT CAUSES
~
~ o .?d;~ ~ DUE TO (b
{J~ tA~ wod~ oJ dyiwp.+Yo.bid rowditiowa. iJ sRY~ ~nRD
i-~ .Y~ ~ ncA a~ Aea~t Jai~r~~.'riw to W aboe~ taw~ (a) ~Wt-
'"i i astAenia. sta !t w~aw~ ~~o ~ r'~~1~^wo tQ~ DUE TO t)
fif O f~ tk~ d:ua~e. iw)r~11. er -
'-3 ~ cow~y::eation v A i e A. OiHEII SI6NIFICJ?NT CONDIT10N5
~ ca.aed 1saeA. I
Co*ditimu cowlribrtiwp to tA~ dra[b btit not
' rr!r.tt3 to th~ disrnwe or ~ondit~on teasin deatk.
Ita. DATE OF OFERA- Itb. MAJOR FINDtN65 OF OPEi/?TiON 20. AUTOnY7
f ~ TION ~
~ ~ j'. rn No ~ _
~ p~op~pb? ~6pcusl 1216. ItACE OF INJUAY ~c.s..~sa•~~~ (CITYORTOWN (COUNTY) (STATE)
~ SY II~. ACCIDfiNT I e~w. tua t~cwq. nre~e. oeuv ~we-. Ks.l ' l! e~r~4 ~tw Y[Ji~LI ~
~ M~ su~c~oc
W ~ H1
~ ~i 21d. TiME l?tata) tDV) 1[a~n ~Ilwn j 21~. INJURY OGCURicD 11F. HOW DID INJUt GUl7 -
~ , OF ~ ~Nll{ AT M071NI1[
~ INJUI~Y ~ i •oRC ? ar~owc ? (
~ Zz. I nereby certiJy lho~ I attended tAe deceased /~um ?-~?7= 19~~ toT~?- . 13~., tAat I Ias~ mw lhe decea+cd
; ~ $ rtlire on - , 19 aad tAnt dratF, accurrcd at m., Jru~n !ht rnuaes and an t$e date atated above.
i iaa. SIGNATURE IUeYree or tit3e) ~21b_ ADDRESS 73e. DAT~SIGNED
E ~ P' F'•'atkt rs " 7 ~ K~t'1.. I 7_~~_~'~
i n~-, '`4a. d U 4 1 A L, CREMA- 2<b_ DATc Itc- NAME OF GEMEiERY OR CREIAATO~ Nd. LOCAiION (Cil~, tows, or eonoqr) (S~tateS
~ ~ ~.TION, AEMOVAL ~cpeal4y ~ '
i"'L'~&t10~'1 Jul~ 29-~3 Ba~shore Cre^^ '~i *~i la_
~ (J.l ~IS_ FUNEIIAL OIREGT R'S S16NATU~E ADD0.ESS
~ DATc ~lEC'0 tr LOCAL I1E615TRAR'S 516NATURE
~ RE6.~
E ' ? '~f~ o~ r.T1nP ~ nP z]~Y+i en~ 4 T ~ *"i l +-nn ~71 YY3 k } _ nrn;~ _ :~l _ '
a
~
~ F ~ - .JN~F~ \ .
' St1 ~y'~` . ;*~~~i:RT ~ ~
~ ~ ~ - ; .r.~~--~ . -
a- . , •
oattify tt~b to bo s trw end corrott coPY of ttw Lo~! ~ y 21 ~N ~ ~ ' i~ ' ,
; ~,:r~r MAR 1;, 3 1:'
i~~istrers record on file in tha St. Luc~e Gounry Ho~i~? ~Pa .
h, ~j r -
~ mant st Fort ~iQ~ce, Flo da. , ~-y,~
(y~3~n,ny: Not va~~d'unless ra~sr.i sea~ :.f tha St. l~
~ ~ 2'7628~ ~ ~
Gounry Ho~lth Oepartment is affized.)
~ ~ r- ' . . . • S
~ y
,
~ N. 0. MIILER, M. D.
~=5 K r b L,ocs~ it~istror J. d ,
i ~;nty ~Hc:~lth Off~ s ~ ! L'0 ~ ,C {
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~ ~ Rpistraf
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" NEILL ORIii1N JEFFRIES S IIOYD (~r
~r~AHTERED 'i 2~j'~ FA~1[~9~~ ~
' P O B07c ~270. FORT PIERCE. FLORIDA 33450 - TELEPHONE 305' 464-8200
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