Loading...
HomeMy WebLinkAbout1146 rv- + ~ • - , ~ ? - _ . . . ' REt; 8544 Pc1177 . . . . . . - . . - . ; . ; ~ _ DADl~3 COUNTY ~ DEPARTMENT OF PUBLIC HEALll'8 1350 N. W. FOURTEEN STREEI' ~ MIAMI~ I+'IARIDA 83185 _ ' " ~ • L DEPARTMENT OF HBALTH dt REHABILITATIVE SERVICES ~ DIVISION OF IiEALTN ~r~~roN s. swsu?w, Mo. Mh+. oiwecrow _ _ __I. ~~--~RT'IFY '19IS TO B$ A TR[JS COPY OF THS LOCAL RSGISTRAR' S It'~(.'ORD QF DEA S ' - ` ING s • ? ."~'s::' P[TPY RSGIS g ~ ~ valid unless the raised seal V~~ ~0~ ~IT k. ~ ~eau of Vital Statistics - MIAMI, FLORIOA - ~ a. Z ~ % ~ ~ , a :1 7!~. _ _ n S ~ ~~f l'A~t~f!. j . + I~ ' • ' RTiFICATE OF DEATH =.:~=f...r::~ ~1: ~ , ~ ' - - ~ ~ _ t~. ~k''°`'m~„~ ~r ~ F L O R I D A srwTE F~« No. ~ ~ ~ RE~i16TRAR'S HO. :.:CE~SED--NAME ~ ~ ~wsr j~% DATE Of OEAM ~ rON/N, O~t, ~f~~. a ~ \ ~R ~ - JAMIN LAVENDER ~ ~ 1 19 4 ~ srCE ..»~re. ••~c~o. ~rte~t~w ~ ihon ~ a.t u«o[~ ~ o~r DATE OF HRIH ~..o..M. o... ~cou~+Tr oF oE~m t~w ! _ : S~fUrr i ~ ~f ~ -aqS. D+K MOY~S r~a. ~ew~~ . ~ii?7 ~ TG~'`C ~ W~:ITE . : s.a 0- ~ k •MAY 12 1903 ~•DADE ~ "~~~C ' ,.,..,-w ~~:*t. TOwN. O! LOCATION Of DEA .ws~w cm urws HOSMAL OR OTHER NSTIfUf -NAME ~n w~ tn..u, ~~vt stet~ ~.o .aw.su ~ ~ . =~faie vcun •ts w No ~ - , , MIA2iI ~ "ES V5'T~'RANS ADMINISTRATIOti H~SI~ITAL _ _ r~=~-c;_ f 5iA'E Oi lIRTN ~~r not a+ V.S.A.. MWf 9d OF MRIAT COIINTRr MAtRIED. lEVER AMRRlED. SURVIVN(i SPOUSE i n.vrt. am .uotM N~rt ~ -~(~j~ v~ p~` ~ towm ~ WIDOwED. WMOR~O ~ sr[csi ~ A< ~ ALA.B_AMA • O $ A MAR; IH•_D ~E~_EN_ LURIE _ A~i~ ~C.i~l SECURfilf NUWER USUwI OCCU?ATION ~aot i~o a Mroea oo»t oun.w rost or KRM? OF M15lJESS OR MOUSTt~ rr v+acaw uw, tvt.. u ten~m ~ • 41b-36-9J-~Jl ~~•11 S C AS SMAN » U S COASi GUARD_ s- '~~~y wsqe tm iw~ri STREET ANO NtM~~E~ ~ESiDEr~CE-S1A1E CWNTIf CIi1l, iOwN. OR lOUT10N ~y~cn. res o~ r~o~ ,w • ~4 u~ ~a 0 0 112 E;~"f J1r~ F.TNER~-NM~E r~~Sr rmoae iwu MOTMER-MA10fNN4ME ~MS~ +wat uS~ T ~ 4 I CH i NFOw~utrt-w~tµE ~N~T. R e DAVIS ~`1a1 ~?~e+G /?DC~tESS ~sneet o~ n. ~o .~n. .r row.., sun. rr~ y ~n 1201 N W lE~ STREE'~' MIAMI~ FLORIUA - ~~a r ~ DEAiN WAS GUSEO t~: ~ENiER OrKY ONf UUSE /fR tlKf fOR (ol. fAl. ~1i0 (c)I nn+~Er. o..s~~ ~w os•rw r~lYU~ UYS! Bronchogenic carcinoraa of leSt lun~_ . as . covsta~•'re or . C~vD~:iOMS. 1/ ~M, ~"-s 4 ' . f . . 1.. 'di~ r.iCw G~vE ¦ISf W ~ ~e~ - ~ . ~ r[D1~lF (~USI 'OI, py~ ~O. G~3 ~ COwSEpVlMC! O~ ? ~ , S1~fING TM! YNOf~. - ~ 1 . wG C~Yif l~f~ I I',:. is~~ r` ..7 - - a ;I y - . ~ wUtOKt ~f ~ES wne M1NOINGf CON- :i OTHER SIGNIFICANT CONOITIONS~ ca+ano..s caa~n~ut~rq ro oe~n~ ~u~..o~~~furto ~o uust r.wt.a rur ~~o~ •!3 O~ ~+Or LOl~fO ~p OltEW~.~~NG uv3t 3 Y68 i N oe•~~65 :.-:b~btrl ~CCIDEM, SUK~DF O! DA E OF lUUR'f 1 MOMiM, ~t, ~F~~ 1 HOUR ryQW INIURY OCNRREO ~lMt~ NtlWt M IMIYft u. nn ~ o~ nn u, rt[r ~ :"N~.C..DE. CR lNOE1E~M:thiiV t .'•i~ M 2k M IM ~ ~~:IURY At WOtK ?twCE Of wr.~r.~.~o.a. ~~~r. SrKO, ~Ktq~. LOCAfION ~sneer o~ ~.r.o. wc . cm o~ ~ow.., snn i xO S~f;~~~ ~iS O~ MO~ ONK( NDG.,l1C ~SMC'!~1 ~w Y.1 7M ~ ~C 4 rERTtFICw(IpN- ..OntN D~t •IM ~~M C~~ ~l~~ A~ 41i y,~/ NW/ti~~ A/M OM 1^O/OM NO~ ~Mw M D[~fM OCCUHED •f Mf ~tK.f. Ow ~M[ ~y' ~ i fM~S'~~'~N~ YM~M D~~ ~!Y ~OO~ w1:l~ ~I~M. ~tir~.l~ D~rf. ~•~O. 'O Mf ~tS~ . rEr:atc rwe TO T o. •.n.uaa. out ~ ~ .._,'A,<<.,,,,.o. DEC.17,1973 ~~nJAN.l, 19~4 ~n~ Ati.l, 1974 n, .,~.8:05pM iOMf(~USfiSISTaIID 7 CEFi:~~r~TtON-MEDICAt El(/UMWER OR CORONfR~ pa TMF Y111 O~ T~f HCMI~ O~ Cl~M ~Mf 0(CEO(Nt ~~S ~~p~d1MCfD Jf~7 .~~n.+ O~ 7wf WO~ ~eW/M I11~ W/fSl~f.~rpN, ~r~ r~.Mr~ux~, ~ rONih D~r r(~¦ wnu• ~ rn ~ r. ~~-~-~u~rto O+ MF D~~! uiD OVt ~O ME C~USE~S) S~w/t0 -r ~.Lm M '-EG•~oIER ~lAME .trn o~ rnNn SKsNAiURE',' o.,wet c~ nr.e ~DATE SK~NEO ~+~o~n~, o.., ~e~u ~ j 1_2 4 ~ P. ~~r~, M.D. i ~ . ? ti•,, r~G ~OORESS-CERDf~fR sran o~ ~ ~ o«o I~~in a ro.+.a- sure nr w : y 1201 N.W 16 Ter~'a,re ~ Miami Florida ~ ~ } ~ 8'~D~~t. CRENUT1pN. REMOVAI E/MEiEfY OR CREMATOR~-NAME ' IOCATION <~n t~ ~o~..~ s+•rt ~ ~.~F~.rr ~ ~ Removal H.Pine Crest Cemetery_ .~u Mobile,, Alabama _ ~ r.'E r..o.a~, w~, ~t~~~ fUNERAI HOME-NAIME ANp AOOtE55 ~ snen o~ ct s wo., tm tov~n, su~e, r~r ~ Jan 3,1974 ',,.'Jan Orsdel Northside 3333 N.E.2 ~venue,Miami,Florfda 33137 ;,_i•~ j~{~y~~~ UDf ~p.~ 7 fUlE OA~E t(C,E1~E0 ~OCM tEf.~Sie~e . " ~r ~ - e ~ ~ ~ v~~i~ = ~3~~ - ..,..-.v. ~ ~ , • ~:s~ , - _ _ _ - - - - - - - -