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HomeMy WebLinkAbout2971 7~~2 ~1~34 4 3 c w~33 40 a ~ `~1 OCT II PN I :31 ` . ~ , i 283204 ~ ; _ , ~ ~ DAD~ COUNTY _ . - . • ~ ` ~ DEPARTMENT OF PUBLIC HEALTH / ~ - ~ MILTON S. .sASLAM. MD. MPM, iSSO N. W. FOURTEENTH STRHET p~RECTOR ~ ,r"~' ~ MIAMI~ FLORIDA 33125 ~~'~~'i~?~.R`. ~ ~ ~ pricu? ~M1~r~* . - M wt tAU~n?. ~ ~ . ~ A ~ . - . • , ~ ~ ~ . . ~ CERTIFICATE OF DEATH ~ s tkP..+~«~ ot Ikald~ ~wd Re6aL~luati~e Senicea lTATE FILE No. : IMyWO1V (lF tiFAl.lll F L O R I D A REGISTRAR'S NO. ~ I N w~r~ ~ wru ~r•e~~n . ; x r,oo.e ~~s~ SEX DAiE OF OEAM ~ rowr~, o•~. ~~•e ~ 3 n c OEtEASED-NAME ' ~Z ~'emale ,July 1, 3~972 ~ ~ Kathryn A ~ 'r ~ ~ • a~m iUCE .rwi*e. NeGw. AYl~KAM WOI~N, AGE-l~Si ~Ma~ ~ re~e u..ot~ ~ o~~ DATE OF WtM ~•~w~rM. o~~. COIlIJT1f OF DEATM « ~ ~Cp ~~a •~nus~ ros. w,s Mo.ias .ua. n'~~ r,~t~ ~r~ ~ s.«~. ~ '"~jl ~1ov. 18, 1920 Dade ~ , White ~ k . - . • _ CITr, TOwN. Ot IOCATION OF OEATH ws~oe cm u.un Np5f1TAl OR Oil1ER NSTITUTION-NAME 11i !QT IN II(II!\. Gryl S~~El~ ~~O NYW~~ 1 ~ -_L S?lCUf ~ES O~ MO C(r. Yes Cedars of Lebanon Hospital W _-.-+Zr n $TATE OF W1M 1 u r~Ot ~M Y.S w~r! C111ZEN Of w1uT COUNtR~ MARMED. lEvER MARbED. SURVIV/~1G S~OUSE ww. cne rwwE.. w..~ ~ c N-nv caw~m i WER O ~ snc r~ ~ A 1 L3T1Z 3 ~ r m , Virginia , U. S. A. ;~arriec~O1CE >D SOCi~I SECU~1? NUNI~ER USW?l OCCtl~ATlpi ~wre awo or .~o~a oo..e ow~•.c ros~ o~ KWO Of MISMES3 O~ ~NDUSit~ ~ vio~w ~ue. e.e.. r ri~~o ~ ~ .t- „ ~nobtainable ,a Housewife ~s Home REStDENCE-SL~E A• COUNTII qi1f. TOWN. O~ IOCATION wsro~ c~n urrtf iilEET Ml0 NtIM~E~ ~~~~•r t ~ sr~cN •s o~ uo ~ _ Venzuela • None . Maiquetia ~es ~~Aero Puerto ~y IN . R~ •~+NAME r~nt ..~ow~ ~.sr MOTIIER-~tAWfN NAME nnr ,roou us~ ~s Geor e W Am.rnan Sr u Put Hoa I NfORMANI-MAME MArYiCs ADGlESS IStYf~ O~ t.r.0. rq., Qt~ W tOrw, Siw~E: IM~ Geor e W Amman Jr ~n1001 S Hicko St Meibou~ne Flor'da urws~.u ~N t v~ iART 1. pE/1M WAS CAUSfD ~7~ (fNiER OlQY ONf GUSE iER 11NE iOR (o), (b). AND {c)j ~!T'M!W OM3l1 wrq ot~~w ~i ~...roui[ uuu • lal ~ ~ ~A.Jl7 ~S A CONSEpYlNCt O~. ~OwD1~lON1. 1/ AM. ~ , '~V` ~ ~ . ~~~cM c•~e ~~st to ib1 ~ ~rrFDl~i! C~YSE ~OI, py~ ~O. M ~S ~ COtiTlOUt1+Ct O~ ~ 3~~7~NG TwE YMDl~• ~I viNG C~YSE l~it ~UTO?SY IF rE5 r+e~c •IMOINGS COM- ~ (~1 t € 1 ?ART II OTMfR SI~aNIfKANi C~N~~110N5: CO~a1~pr~1 COM~NYi~e~G IO OF~M ~ul wOt fEU~tD 10 C~USE Grvtw IN I~~1 e 1a~ 1~S~ MOI LDE~ED ~N Dltf~rvatNG C~USE ~ p/ Dl.~IM s IA' ~Np 11! i~,oboN 1 ACCWENT. SUIUUE Ot DATE W1URY ~.oN*w. o?r, .t.~r MOUR HOW IN1Ul~ OCfUt~E~ 1lNTF~ M~TV~E O/ INIYt~ IN ?A~f I o~ r~n n. ~ft. ~ HOMtC~~: OR UI'~Eif1MINEC _ ~ ~h1 ~ 70~ M ~ol ~N1URY AT MIORK rIACE OF WHllY ~~'b"E• ~•~r, snt[t, r~[toe~, ~p~Anpp~ ~ sneE~ o~ ~.r.o. .ro.. un oe torN, sr.n ~ . i snun as o~ MOI d~K! NDG.,l~f ~3?K~~~~ t0~ ~ ~ ~~T~- ,~p~~M ar .ew~ rO~TM o•. ~e~~ •,~p ~,s~ S~w ~~Mt~ w~n~t o.+ ~~/oro ..or v~cw~ dt OEwM OCCU[lED wr m6?u~ce. a+ TMt ?.wrN o.~ n.~ ~oo~ .~m a.m iNODU A o.n. ro Me ~cs~ .C1-M: 1 O~ r7 liAwtEOGE. QuE nEwo[o m[ ,~1~T0~, t 19~ 11~ 3~ (97~- tt/ Zl~ M to iwt c~ustisAuno. 71~ DlCF~SFD ~~Or CEQtIi1UiKXi-MED t EXA?~MiER OR CORONER- o.. rN~ ~.s~s ~wo~ o. w•~ ~ME OlCEDFNI M~S MOMOUN(FD Dl~O N Mt O~INIO~~, YGNTN wr •F•~ ~u¦ tt~~~NifIQM d/Irt WCt ~NOIO~ IIK INY~S1Ks~T~O~'~. ~ Gf~rM OCCYMlO Ow ~ a~ WO DUt W M[ C~USEISi ST~t[D M - M 17. ~tuRE w rrt~e Dw SIGNED Ird~M. M~, tF~ll CERTI///flER~-N~A,,INE ~nre oe r~i n t r~~,~ ~w y~ Z i3~Gn-E W C~ G~'C N i` ~ ~~n o~ ~o.+» sr~n nr - ~ MAI ~,j- Ofrt S~~ttt M D. r+0. _ 11] l(.~U ~ ~V~ ~~t~V~~ . _ CfMEIER~ OR CRENU?iORY-lv~E ICC~i~ON u~ w~~ ~*~tE 6URUl, CREMATION, ItF/~OV~t sreun ~ Removal Brevard Mer~orial Park Ror.kledge , Flori a DA1E f~~ ~ FU^1ERAl M{JI N AND E i S1~FEi O~ O M., C~7f Of ~i11MN, S~~~f, l~~ ~ . ~uly ~Stanfi~l ~inera~ ~omes 1o5k5 Dixie Hwy Miami, Florida 33156 ~ Z~~ - ~DAtE lEGfrvEO ~t IOC~I tEG~Sj~(1{^ ~U*~E t OR-SIGNATU REGI R ~ TN L 3 ~I L tss ~ 4 - - - - - - _ ~~Q~~~~ `tZ~ _ ~ ' i ~ r 1 • pVS TO BE A TRUE COPY C~'' TfiE LOC}1L REGISTRAR' S RECORD OF I ~ - . , ~ :1.` ~ ? n~~~.- .~+t, F~,,, ~ ~ , - _ . • ; C j . • ~ , , , ~ • ~ . ~ : _ . ~ g; ~ : ''~t~s: . ~ , _ ~ g c= . r~ ~ ~.,+ra~'~ pnless the raised PuTx REGIS f~~, 1 p}z`~ Bureau of Vital VITAL RECORDS UNIT ~ - - • - ~ $ta~.t~~~ios is affixed. ) DADE CODNTY HEALTH DEPARTMENT - t_ ~ / . MIAMI, FLORIDA •cR~as ~r~ ` ~~,~f~` '~~y ~ ~ ~ . . r~ ~ / c~-i F~6E~~ ~ ~ " i : - r ~ ; - ~ ~ .~Y ~ ~ tc'_ ~ ~~~~rF~~ _ a . 3..~a~ _.':4 y. . . ~