The URL can be used to link to this page

Home My WebLink About2133 gT~: u~ ''a~s ~T b y r 4 t:: a~~ - `f t7 J I r F. , ra~'~'~'~ ArR 3 I~~ YN'ia 2~~~~9 . - --G~4~' 1 F I E D C O P Y . - - _ ~ . - . WE HEREBY CERTFY: ~~~t~?rQ Y~~'~PRppUCEO BEL~W TO BE A TRUE AND CORRECT COPY OF THE ORtGI ~ j!~ ~pNtiiLE IN ~HE BUREAU ~F VITAL STATISTICS OF TNE STATE OF FLORIDA.~~~R.I~A H~1lLTH AND RENABIUTATIVE SERVICES. DIVISIOPI. OF HEALTH AT J~,N~/~t' ~D/?r ' F =i ~uyi' t tNOt VALiD UNlELS`~{= ~-*QE .r~ORIDA. DEPARTMENT OF HEALTH AND NEHABtItTAT1VE ~ : sERVIGE6. DIVISION Qi'! ~ ~FFI;[~i~. . . - r ~ ~ T' . t . ~~~C~~ \ U R V" ' _ ~ ~ ` ~J~\J^~ ` ~v 1 j1 ' t'. GMIEF. \YA[AY 0/ VITAI STATIl71G~ "Ss %Y:#~1~~ - . _,..'"g_ ~r . f i' ~ ~73;: ~ ` ` z ;,~ti~::cU 3a ~is.":',t;;~~ _ .y1'1~`~. ~ ~~i'. ' 1 , . ~ _ . ~ f y.~, ~ l7AT[ R[GIiTtAw: OIR[CTOw. DIYIf10M VF ~ ~~1~~~I~ ' REHAOIIiTAt1YEESERVIC[~ OF MEAL7M AND ~ *lr. st " ~ ~ - - - .,,,a~-- - CERTIFICATE OF DEATH O~ 7 9 7 7 . Oepar~~nenl o( 1 ka116 and Rel~ak.~lda~i.e ~«s F L O R I D A sTATE F~~E Ho. _ ~H~~von t~ t~?_.~ ~fi • ! • ~ ~aaavwm.an.r~nn REGI57RAR'S NO. ' ~j ~ U~•.1 ~ OECE~SfD-?~AME r'~:[ ••s- ~a pwiE OF Of~Tn ~ ~~~rw, o.., , ~'~tII. i~''~S~ 3A~``~r;G~l~: ~~:~.I.E 13 ?:arc~.. ,;7~, ~ RA~E ~/+~~iF, KlGW, ~rlfK~~. ~~L~~~ AvE-.~5' ~~~'Of~ ~~t~• ~j ~UM_Ot~ ~ D~~__~ DwtE OF 6iQTM +:ri'~. w~, ;COUNTYOi OEwTM !tC ~ S~lCnr ~ ` ~ ~er •r • tf~ei: .~OS T Or~l } _~OWS ~ r~r• •t~~ ~ . ~ WtiITE ~ ~k ~ ~t•r.e ?.n,' ~22 I„ ~va? Cli~l, iO~MN. OR IOCATION Of ~~'r ~•.iwt tm ~~r~ri HpSMTAI CR OTMER l15TITUl10N-NaMF ~oi F~r~t~. ~~•t s~nFe •,.~c ~~+~e~ : S?tC~~~ 1[S Ot NO n ;.Tac'-:s^r.r;l? ~ ;res 2;aval u~s^~+a? - STA1E Of WRTM ~ u wo~ u s• ~~~ndEN Of wMwT COINriR~ MARtlEO. NErER AtARR1ED. ;SURVNNC SPOUSE Y+~~t. one r~rot~+ ..~.~t : ~ c::.+-r ~wIDO D~vO E vi-~~.. , F?or~da ~ ~G.A. ~arr~`e~ -_te~ Barr~r.~t~*.: - T_ _ _ _ SOC~~1? SECUMTtl NUMlER JSUwI OCCUP~T~OH ~~n .~.+v or .o~a oa.e o~~~..o res~ C~ : KIND CF BUSWESS OR INDUSTRY .~~n.ae ive, e.e» ~r ~tn~eo ~ ,y Se~ n ~1 Z~ ~1[~C -`C~-~ ~.f i ~ i'• : RfS1DENCE-STAif COU~ CiTY, 70MIN. OR IOUT~ON c~~ t~..~is TTREET AND NUhUER I ~ v~c~.. n~ o. .~o ~ Florida =r-~ a= ; iG ~ zc'.;s~nvil? e ~i F= 6b~?5 Valiant TJr. fAiME!-NAME ?~n~ .~oe.e i•sr MO7HEY-MAIDEN NAME rusr rwat Us! . „ TOBE ~YS ~IS. A~::~LD IWONMANt-wAME (MwIMG wDGRE55 ~~ni~t o~ ~ r o.a.. c~n w rovr.., u.tt. tr~ L '11' 1 . ~ _ l 1 1 ltn ri^s_~ Il~ G'~-~?% J'_~. c~C::S^~'J~li£' __w 2? _r ~ar_ - • ~~MOU.ur ~~Ktt~ru r,utt oEwtM wws c~wsfo ar [ENiER ONtI' ONE UUSf IER lWF fOR (o), (bl, AND (c}~ {[~ht[tN OMS[i ~NO Dl~M ~..ea .a uuu ca, ~ore~Niratory Arrest ? Hoizz~s ~~I , 01 ~S ~ O~SEOUtKCf O~. _ I f ~oN~~.~oNS. balance ~ _ I/MICM c..i us~ ro Ib~ ..E' ~2bG~1C tI1 f ~+reo~.i[ uust ~o~, ~ a ,~,5 . ~p.~ytpyEwCt d. ~ 5~~~~NG 1Nf YNDE!- ~ 2lan a ~s, ky Act:te and Chronic Alcoholism ~AIT 11. OiHER SIGN1iKAHI CQlDII~0~+5: edeanan eo.awun++e w a~m w* Mo~ ~cuno ~o uvx aM. n. r.n ~ wr AUtO15Y ~ rE5 vr~a nNOiNOS'toK- ~ /rfS O~ MCI t~OE!!O IN D[7l~~N/MC G~YS[ Oi OlI1TN Chronic Panc^eatitis ~w Yes Yes r ~ ; ~iedpfTE Y iED ~ ~T ~ ~TM, w~, ~tA~ ~ MOW IN1VR~ OCCURRED ~ t~~ ~'wn iM rwrt ~ oa r~tr ~r, ~r r ~ ~M ~ !k. M. SI. ~ IH1l1RV ~i wORK ruCE aF t~lu~tr wo.e. snen. ~.ao~r, IOUnON ~ snen w e.~_e. .w:. lti~ Of T0'~'N, s~ae ~ ~swoi* ns o~ no~ oR~a ~sc.ic ~sra~n~ ! Ir. 7~ ~ ~~~t~_ ~M p w reMe~ o.~ •[u ~wre w~~n u~ow ~~~~rtn Otwm ~ OE~R~OCN~tEO w~ ~ p aE ~lsi ~rTtltuw: TO a ~wwuou. eut ~ ~ ~~~.ceo na ~I~ tlc tt~. It~ M. ~o a~e uwsEa~ s*~+co. Ila ~ttenuo rwr ~ Cg1HCJ?iION-~~CAI QI1Ml~ Ot CD~ONEt- w~~.us a n~e wa d a.n rne o[cea~r ..s .w~au.Keo wn ~S ~a~r...ao~ a re wo+ ~uo/oe a~s~e.no~, r.•• or.no~+. .~aaw w~ re.~ ww ~ euw octw~ ou we we rua w+o c.~sia s+wna. K~ NL ~ . C@ANft-NANE rt+rt a~+n o~ nne OA 51GNE0 ~ra«m, o~~. rt~a? ~ Austin Cdr.HC (~l.D.~ a?: ' ~r, t~arch 1I~ 1970 ~ ~ David A.~ . ~ ~"~~~~'~i~ta2~ Jackaonville,~OP~.~S ua oe .o.~ . u~n . ~,~1 3 Weat. QEW?T10N.11FMOVK . Ol taEIkATORtI-NM~E lOCwiWM cm o~ w~n st.++ _ Reaaval ~ . . - ~ Ft:~ P~.ercef Fl,~rids : ~ ` . ; D,~ ~ . p~ RAl MOII~-MAME AND AODtfSS ~ sue~i w r~~. wo., trt~ o~ ~or+M. a~n. tM ~ . _ , ~ ~ ~c~j~ ~~rdage & sans > 53 ~B3andin lvd. ~ Jackaom?ille ' = Florida ?21 Q~ , x ~ - --sicnnn~OE : r` tUl Ci " ~ _ - - - . ~ ~ _ _ ~ ~ . ~ ~ ~ _ ~ ~ FEE, PARKER 8c FEE. P. A. ATTORNEYS AT LAW ~ P09T OFFICE BOX 1000 ~~FORT PIERCE. FLORIDA 33450 DG`~.~~~/ ~MY~ Nr ~O TEIEPHONE: 130'Sl 461-5020 ~ " . _ a~.r _;a,'.r~~ ° - e~ ^r,p~,y.A „ct ^..:-s ~ .,~=-'~s .y .S .3°1~ ~ ro.~.;~,y+} ~ ~4 ~ ~ ~-1 ~r' ~ V . . ~_._e . > _ _ z ~R . _ - .