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Home My WebLink About2331 ~ ~ ~ ~ _ - CERTIFICATE OF DEATH 's ~ Qq.n.e.l .f Ik.ld~ ..d ReL.611u.tl.e Senke. srATt /IL[ Na ' . ~~~~~~n+ FLORIDA = Tr?f. W?tlM IN °1~"w°'~~~0 R<OIiTQA11•• NO. i i ?ttMAN[NT INK ~EA~_~E n~te ryw u~s~ SEX DAIE OF OEA1M ~ rowtw, ~~t, rtu ~ i SFE IIw1001 fOt '~'"K10i~ ~ el a 3 i l = ~ ~ RACE rwn. rww. ur~KU~ www. AGE-ua~ we~ ~ rw ww~ ~ e~~ OATE Of MRIN ~.a~. wr. C01MilI p DEwiM ' i tx. ~ vecw ~ w~~u~ O~~uua~ ros. wn rows •M w~Lay Unk ~'Ml~l ~ f ~ ~ ~,I~l~te S~ 6cl A k. • ~ ~ q . • CI111. TOMM. Ol IOCATION OF OEAM ww an ~wn HOSMAt OR OTMER NSTRUI ~r ~p w~mr~, c.w swt~ ur w~ro ~ y ...~w a ..o „ Arcadi a ::o „ G. Pi erc~ :•lood : fer:iori al Hos~i tal ! SiwTE Of Wts~ ~ r ror w v~•., »..u OniEl~ Of vnui COIR~ttr w~RRlEO, ?~EVER MARbEO, StltvnNG S~OUSE .rw. ow .wM.. ww ~ i „tivy.?e..K.• , :entucl:y ~oM•••~ ~ U.S.A. 1•woowco.wMOacFC~wan~ 1' i s.en acu~ee uno. u«•w~ SOCUt SECUNiR Mli+~ER uSU~I OCCWAT~Ow ~ w.e aro or .wc oaw owwc ..oa a ¢MlD Oi MlSNESS OR k01lSTR11 ~ GCCUMts w WuwG ~~N. Mr~ w qu~ro 1 ;;u;;;~ u;~ 413-Q9-0821 „ UnE;narrn Unkn m ; .~.,~sa... RE31OE?KE-St~tE COU?~tr Cttr, tOwN, Ot lOCwi10~+ ~w~ cn urws Si~EEi wND ~vecv. n~ o~ w . ~ ,M F1 ori ~a ,w St. Luci e Fort Pi erce ~.,U?:kna:n ,M 3601 S. Indi an Ri ver Ori ve; ~ iwTMEt-NAME ~ns~ .uoou us~ MOTHEf-MADEN NM1F ~rf~ .»ae uW i „ Unkna•m ~ - L'nkna:n ~ 1 INtOf~ur{~-?~iuwE ~ ~NtsaG ADGRESS ~swen a~.ra. Mo.. ew. w ro.... iu+e. ~ ~ s, • L . ~n GP~~;~:~i °eC01"d5 P. r • j ^ ?~ut i ptwrn wws UuSEO (fMEt O?~l~ O?E UVSE IE! lNE fO! p~, (6~, MID ` ~ ~ ~!M1ltN OM1f~ ~M~ Of~fw ~ ~.wwn e. se , ,-,~y 4 0.9 ~cute ocardi a1 I nfarcti on 20 Nours . „ , ~ ; ~7~:a:::;~: o 412.9 Chronic Iscnemic i'eart Disease Unknawn ; ~.rea•u c.~s~ w~. ~ ~~o. w•f . co..uove..ct w ~ fr.u.a ire YMOE~- I f ~n~a c.ou ~.s~ ~ ` ~cl { ~ARi OTNft SIGlI~KANi CONDIiIONS~ tp•wno.~f Cpww~utwo p ouq ~rr MO~ Murts W GwH OnlM w~Yf ~~w A4ROK~ f tEi .r~~~ ~~ra..as ca.~ f ~RS O~ MOI 4NY~ IM pf~WwMG Ca11fl ~ 5~?J.~!.aM9~~ DIABETES .?tELLITUS. 427.0 CONGES7IVE yEART FAILURE. . , ~w S IIOM100E: Ot IIWEiE /WINfD DA ~.wi~w. wr, ~t.~ ~ ~10UR . NOW INIUt~ OCCU!!ED ~ Uw~ wN~t W wwtr ~w ~~n ~ W~~M w. Mfr ~ ~ poK.bl E m\ ~ 7M M tY ' x INJtlRY Ai WORIC ~CE Of wxKY ~.wa. ..W, s~~e~,, r.n.,... lOCwnOro i fnen o~ ~.~.e. .q., dn o~ q~, srue ~ ~ i ~ snan ns o~ .a • anee t~c ~ sncu. ~ j ~ ~ ~ ~f ~ CEeTwUT~ON- no..r. w. .w ~ rwwi o.t .w .w us~ s.~ wr~.e. une w ~ Mo/ao ua .rt.r Me oEwn~ Oeeuneo •t me•n.n. w w ~ ~M~lKIwN: rOi.d W AY ~OY~ U~N M~ I~IOV~~ M4. ~M. ~D M~ll~ ~ ' 9 11 1 g72 'O ~ ~ 9 15 1972 :~~~i d not ~u7 : 40A M o ~ ~ . ~ ~~..~o ..o.. ~~.9 15 19. 2 k CERi~KJ~T1pN-MEO~CwI ElAN11NEt O! CO~ONER o.. rwe uvs a. ~we ~ww a a.~. rwe pcew.~~ r,s rw.~ou.~c~s ee.o ~ fau~u~0~ p M! q0~ ww0/W ~wf .nti~~G~rpw. ~n O~wM». r0'+U~ M~ nw~ wDU~ ~ p~~~M pCCVtlfD OM M D~p ~Mp OY! W M UVSl+L Si~tlD m • M ~ k CERTiHER-nM~f n*n w n~..r, S~C,r+ATItRE oeere w nnt ATf 51GNEO i~b. a~. ~t.~~ P rs b rn o ~ llal~ O~ ~~.O w0. n' p~O+'~ • . 11~R t~ MARNG ADDffSS-CERi1fIEf tl~ ? rF' r• O ~ r ~ ~unnl. GFw~t~O~+. tEr.~ovwt Ew~En~r o~e eE~iOer- ~our~OH un w w... sua ~ ~ s.eev~ ~ ~ ~ Reoeoral. r.. Ft. PLerce Flooc'ida ~ pwTE r.awM, rr. w~ Ft/?+ERAL NOME-HAME ~1V0 ADORESf ~ srnei a~ r.~. Mo., em o~ qrM. n~n. [r ~ ~ ~ ~ Se . 1 1 2 Robarta ra F~neral Aosae P.0 Box Arcad3a Fla. 21 ~ ~ v. 5, s612 Fu+t K?oe- •r J' , eKditw-SieH~nx~ owrt ncei.eo ir iow eea~s~ur ~ qev.ly70 ty ~ ~y tN ~ ~ CERTZFIED COPY f • I hereb.y certif~ tho above to be a true and corroct copv of the Local Registrar~s ~ ~ ~ recard on file in the r~ ~`k,. Health Denartmeht at ~ 4 r ~ ~n ' - ~'~'Q~~g. ~ ` .C.~~\Z\~'' ` , ~j~ r r; ('darning: Not v~ ¢;•,an~s'~~~4 ;seal of the ~ ~[n `L_-~~'~ ~ , ~ Heal . jca ~~f~ixed. ) ~ . : ~ ~1#.'.~;;, 8 j ~ ~ ~ ~ ~ E ' r FILEut~~_ ~'~~1RUEG ~ - , ~ ~ ' - = • i ~ ST LL~ _ ;;,NTY FLA. ~ . ~ . ~ ; - , ' _ A . ~ R,, .-a~s k'. `:r 'u'ri~;f ~ ~r - C~ cHK _ _ ~GU4T . ; .1 c ~_•`!'l~:~n.~~t'r'~~ 4FV' - _ ~ T~~r~e~ _ Date"~~ ~ - : ~ ~,f ~~4. DeAUty cal Registrar ~ = MAR IZ - If 02 ~M 7~ - t-{•c-~<` . _ y~j . _ 2'7654'7 ' ~~:K . . . - ~'r t 224 PA~,E~t~~ - - ~ r~.r ~'r ~ ~ . < ~ t,~rc„'$ -g ~ ~Y3,~'"~..~''_`m.. . . . . . ~ .