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HomeMy WebLinkAbout2996 J Lewis 20642 , F?1E0:.'~. °~i,uRDED ~ - ~ - 2 I I Q`iJ 5T kU~ 4~ ~'l'JNitAS ~A. _ - ClE''X r ;!~?i COURT PF1'r~~ ~ ;t .~.rr ~ M~t ~8 9 33 AN'1~ 2'~7Q~ 25 T~i~ e~- sT~TC eowao or M~TM CERT1FICATE OF DEATH co~es ? BURGU OI VITAL fTAT1YTICf fTAT[ FIL[ NO. 1eji1 FLORYDA otd ~Aen BIRTH NO. REGI6TRAR•$ NO. SZO y~opetlp L~U1C[ O~ KATN GOQE NO. Z_ YtYAI IItNO[IKtID~...I.~rMd l!~w~w~ RrJwsw,w~y~wwi eaeeut~d ~ ~N~ STATE 6. CCUNT~ •~a Saint Lucie 65-025 Florida Saint Lucie e~ yi.c.e ~ p y~r- A. CITY. T01rM. W LOCAT1011 t. K?LACE pi pE~TN t. GTY. T01MM.OR IOCATq11 K 11ES~OChCE ¦~a~wt ~MS~DE U7Y UY~iSI ~rS~DE C~TY l~rlrS? ~ort Pierce rES~ rort Pierce ,~Seg k~YE Of ~ (1J~N iu ~Wj~ql. /it Wttt ~fl~ar) t STRE[T AOORtiS NOSMTAL OR~ ~ IqST~~uTqN D.O.A. Ft. Pierce I,em.Hosn. 341 Hernando Avenue 3 NAM[ Of fn~f 1Ji,21ft Lyt ~ pATt Mwt! p~ Yt~r ~~~~?`r~+r~ BERNAF~D J. TOBIN ~.M November il, i969 S SfX ~ CO1011 OR ~ACE 7. MARMIEO NiVCAMAlIN1[OC} ~ DATC Of ~IIITN 9 A6[ (IAKVI ~f iA~SiE111 tW i.t~OE.tN WK. 11 r t t• ~ ~:i • ~ug • ~ ~ Z V 7 7 ,~1 oyn~ M..~?. L.~. Nwv. M:... MIOOMED q~ORCEO ~ ~ p l~1 nl ~ 10~. ~SU~L OCCU?ATqM (Cve tiw/ e/e~rt M~r lO~- KIhDOi WS~NESSOR 1NDUSTqr tt. iUtM?LAC( (S7Ne ~?~irty~ [N~~~) t2 G7/2fw Oi wiMl Cp/?nf7 •1tA P~r- frrir/wwfNrw~i~Ih/t.neai/?ttird? i Steel ~forker SteeY~ Ohia U.S.A. L:~ei tai ~j, ~A7NER-S J~AwE ;t YQ7NEA~S MAIDEII NAM( Jonn Tobin ~ Unobtainable 16 SOCU~ 5(CUR1T11 NO 17 IM~ORM4 ~ tIGMATYR( A/4eu 312-10-223 ~irs. Viola Tobin 3~t1 Hernando Avenue~ Ft. Plerce, Florida Fun. •~1 1~ CAYK O~ KATN (S+~lp ~w1/ pttar ynliu~r ql. 1~1. ~Rt Id.j INT[RYALlETW[[N Ql~~eto• ~~~1(1.0(ATNMASCAUSED~r~ ~ ~ % j ONSETAMDOEATR •uat tll• ~MwFOU1TE CAUSE -y~~~(~'i,~~V~- _~l/ - ~/jl- - tee c~r- ~ j T . C~ , ~ ~ ~ ~ •ftA tAe C~~1~~•~/~~I. DUE 70 (6) - y~ r~K~ ~~rt tu~ f~ - - ~-~/Jt__- ~ 1 o e• 1 J~e~~ nax (i). reRfstrar t4 r~4.- ~ t~tu !u(. 04E TO (tl-- - - - - - - - AOYf fp~ ~ IA~T 1{ OiK~ SKIIIfKMi ~qlp~fqqf COK~iMlfYK i0 IXAiM RR NDT RtUi[D 10 TM[ TER+NI~ pSL?S( Cpp/)p (~ry[II y~ fMT 1(~I . wA5 ~UTOr~Y tERiON~aEO~ ~ cer de~te ~ YES? N~~ or 4~fer• _ ~~»~s ~ ¦.ttw ae~ r. ~ ~ DESCR~YEHpir~JU11YMC~ARtO (Ewrnw~rrny~~p,r~i~P~rtlaP~?t7/y~r~~fJ 6 ~ ACC~pENT SU1C~pf MpMKIp( atspe~t- ~ ~ _ ~ Q t104 O~ V eoa~. n"E os tt... sr.,u. u.r. f•r.. ~ uuuAr 0 0- w. ~ W ~ i ~ 20~1 ~MJ~111/ OCCUMED mt ?UCE Of ~NIUIt~ fr. i~ w~~o~t ioqt, m/ C~TY. 70N'N. OR IOGTlON OOUMTY STI~ E ' WMILE AT ~ tqT WNIIE ~ N•~. /«~e.r..r..~r. ofic. ut~...r:.~ I WORR ?T N011K ~ . ~ ~ t ~ / - w . 2! /~~~~od~dtMd~c~~asdl~dlir'`y~ ~~VI ~~-to`.~.__ •ndluta~~ A,in ~li.~on ~ _ r D~~tA <tceu~r~d ~t ~ 'q/~ ths d~t~ •ted ~Aor~; • o t • Mst o/ m~ Ano..l~dp, /~om tM uu?~s ~t~t~d ! Ail 1te~s jj~ tICM t• ? • r e to D• ~ ~ ~kP~t N fV l~Li 2i- D'yR ?2t. WTE S~G ~E/O~ ` cu.p~.t. . ~ ~ -;f~~-=.~-!%! _ _ry';a~a~:~~i~l/j, ~i.~,~t;~_ ~ ~ ' V sCtYl~tf. ~ 23q Bdm . CIIEr~ipw j~ OATE 23: ~A~ E [TfAr CR ~~ATQRY 23J LOC~TpN ICY/. lMr~. M tpus//) (Sh(t/ re4~S~~~'""' 11-13-69 1 St~-?Aiary~ s Cemetery Cook Co. Ill. s ".S.~bi2 jy,~F~~~wl GIRECTGR ~FdGh~TGpC Appp~~g 25 DATF AE SD!~ OC~IIlEG 26. NEGISTAAR~SS~Gh11Tb11E ` a~..i~as '"'i-.i- ' ~ I 11/19~69 ~ 'r ~ . ii.~r~2~6^5~ ~trl St. - ~ I hereby urti"ry this to be a true and c.xra.-t copy of th« loc~~ Regissrers record oc~ file in tF~e St. Luc:c Counry N:a!th Depert- ment et Fort P~erce, Flor~da . . r. (Warning: Not valid unfess raised aeal of the St. Lucis c• F': . ~ County Health Depanm.ent is affixcd.) - ,'r;,~'' ' - ' . _ - _ N. D. MILIER, M. 0. • . ` ~ ; Counry Healih Officer ~b local Registror ~ ~ . a..'~: ' ri~ `rrT , _ ~~_rf~ _ y : . ~ . _ ' Dat~ Deputy Lo~cal Rcgistrat . • } . ~ !t~ ~ _ r: , ~ ~ = F:-_~ 224 eacF~;~ . ; , j 1 t . . 4 2 y ~ ~ ~ . , . ' ~ ~ ~ ~ ? _ . . . ~ _ _ . . . , y 3s~.2r- ~:3 _ 3~':.~a-•^:'~` _ ~1