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Home My WebLink About2001 N i ~ ~ pOL..IC COUi~ITY HEALTH DEPAR'TMENT WILLIAM r. MIIL. JR.. M.p. ' o~~ceTOw ~~I ~ CERTIFICATE OF DEATH ~ Deparlacat ol Ilealtl~ ~wd Relr6iliatine $ervtces fTAT[ i1L[ N0. o,~,sa~, oF ,~w~n+ F L O R I D A i 'N ~q~~,LL~„~~ REGISTRAR•8 NO. ~ IK ~EwSEO-NAME n~s~ ..wae us~ Sfi OATE OF DEAM ~ ro~», sw~, ~ ~ Charles C.. DreisSach Male Septe~ber 9 1973 ~ RACE vn+n. Meow. u.t~~cu~ ~~o~u~, AGE-~~s~ woe~ ~ n~e woee ~ w~ OATE OF tIRM ~••weM. o~~. COllNTt OF OEAiN N~ •~~ws~ ros. wn «cws r.+. K"" ' ""~~ii.te '"~o ~ oct. 12 1903 Polk ~ ~ ~ ~ ~ ~ C1TI, TOwN. OR lOU?T~01+ Of OEwTH wsoe cm ?wos HOSMTAI OR OiHEIt NSilTUTION-luME ~r Na n~ nn~. cwe uaer uo ..w.se~ ~ ~ sncur ~s oa No „ Lakeland Yes I,akeland General Hospital 3 STAtE OF MRiM ~ u NoT w v.s.•., .ure Q11ZEN Of wHAT COIR~1TtY MARwfED, NEVEt MAWEO. SURVIVNG S~WlSE ~M wue. an~ w~ee.~ w~w ~ { t v~crn ? , Pennsylvania , 0. S. A. H1DO~ar'r°"~e Catherine Cressley ~ SOC1At SECUrT~ ?~11wER USYy OCCWwt10l1 ~u.e aw a.~w~ wMe oww .~os~ w Itlq Of N1S~lSS O~ lIOllbitY ~ Autociobile Service i Automobi~e Hechac~ic ,x. ~ lEStOENCE-SfATE COYMTY Uir. iOWN. O~ IOCATW~1 ~wLre un ~rof S1~EET . ~ aKCrr ~es w wo f ~ ~'1,orida ~p Palk ,k Lake3and Yes ,.Zl~ id. Magnolia St. ~ ' ~ MOiHER-MA1DfN NAME rrw r~wae uu ~ fATMER-NM~E ~~ut ~i ~ Joseph D~reisbach Joana Buck = n ' INtOitM~WT-NAME MAlNG ADORESS ~uut~ w ~.r.u: i.o., cm o~ tor«, s~.n, tr~ ' „~Hrs. Catherin~ C. i~ceisbach ,n 21.1~ W. Magn~lia St., Lakeland~ F1a. 33~1 ~ ; 1 ~~RT 1. pEAiM WAS CAUSED ~Y: IfNfER OrKY ONF UUSf ~ER LWf fOR (oJ, fb~ ANO IcA ~erweew ousei ~~o w+M ~ ~ uu.[outE Cwutt ~ ~ . , a ~ ia~ ~ a(' ~-a~.~.,. " r~-t.t..~.t. - uo~e , ~ coMOmo..s. i~ wur. 4 i f+~-~`~'.~ L.._lJ?i..._~ ? L~~VI/r~- MMICM Gwv[ bi~ t0 ~ (b) ~ ( ~rrtO~~it C~YSf 101, I ~.yt t0. O~ ~1 b COMS~'~tNK[ p: ~ 51~~1NG 1M[ YMOlF ~ 1 I~IMG C~Yf~ l~l~ j E ~ AIJiOl51/ If YES Mete nr.o~wGS Cw- ~ ~ PwRi B. OiHER S~GNIi~CANT CONWTIONS~ coMana+s co~xn~un~w ~o o~•m wr «or uuao ro c.usE c~r[M U+ ~ur ~~m ~~s uoeuo ~M oer[w~~~MC uuse ~ _ ~ a oe•~w ~ ~b ~f! - ~ ! {?•opobl.~ ACUDfNT, SUK~DE Ot OA E MUURY ~ ra+rw, p~~, rew~ ~ MOUR HOW INJURtl OCCURRED ~ t..!te wni~! or ~N~un ur r~n ~ w s~ut u, .tw ~ ~ NQVK~bE: OR WIDtTERMU~EO . ~ ~ h'~ pr 2k. M. tM ~NJURr Ai wORK MACE OF eJJUtT ~o.e. ~.u.. srnEr, ~.c*o~., lOCwnON ~ snen w~.r.o. ?w . un o~ ro.n., sua ~ ~ ~ s?c:~•r s w Mo ~ op~ea aoe , eu ~ swe.n ~ - ~ ~ ~ CEftTRtCA710H- •wrw o.~ n.~ .~w~m o•~ ~e.~ :''b~ ~ ~`lu~~ ~.r~ina.M ~ ?~l~ED owne~~io~e~eau ~NISIC1/1N: ~ TO L ~ a rr uiwaeou. out ~ ~rt[~eto rMt ~o ~ !U !t~ ~ *o na e.use~s+ srwno- ~ n• a«•uD ~~O" r»e otetoeMi w•s r~a+ou..tro oe•o ~ CERi1fKAT10N-MEDKAL EXAMD~ER Oit COROI.SER- d+ n.e Ms~f os rht wa,~ w u.n~ ~TM p.~ reu ~wv~ l1WMatQ'~ O~ IM! WOi ~11D/O~ :~If Y(~lST~G~TIOM. IM rt WM~d~, ee•m oecuaeo oM w~e o~n .,+o out w n~[ 4use~u sr•no. M. ~ tta S~~T~ weeee oe ~~ru ^ DATE SlGNED ~.~onTM w•, iw~ CERTIftER-N mrE o~ rewr~ - ~ : G!~r-~/ f" C_ c ~ c_ u, rs. F" }~r-.~a.~.---~-~• L( rx MA44K, /1DORESS-CFR?YIER s~ne~ a a.r.o. .w. cm w~~.1~}_ a~•~e ~ O.~- ~ iH / ~ C L- rYr ~ ~l~t1F- . ~URULL. CJtEMJ?TION. REMOVAI CEME~Et1f OR CREMATORT-NAMf IOCATiON an o~ awN sr.rt ~ snan ~ ~ee~oval-Buz~ial K, Big Creek Ce~oete Lehight~n Pennsy_lvania St~ ~ • O. MO. C~n O~ T MN, 3*~Tl. t~~ ~ QA °ATESept."~'1";°'Y~3 ~~~~`~~~~~~pe1 ~o~ YnE;_•a~iam Ave., Lalaeland, F1a.33~xi1 tH OwTE tEC[tvEO ~T lOG1l 1~~ fu.v ~ F~OR-51~?. .~r-,/ RFGtSTRw~, SK''+u?TURf%{~~~ C'~ f f / t i~ ~ / ~ , . . - ~ x?. zs~ ~ . ~ ~ I hereby certify the above to be a true and correct copy of the Local~~.~~~'~~gcord on ~ file in the Office of the DIVISION OF VITAL STATISTICS, at the POLK C~~~~~~~~P~ j ~ a.~ gp~j~ ~*j~pg~. CLfRR Ci;:C!{IT COURT ~l RF~hap vE~i-~ED ~ ~ ' , ~ ~ ' .Ju~ I l I 2~ ~ County Hea1 ~~ice~ ` ~L'ocal Regi.strar ~~9 ~ SEP ~ 3 197s ' yS. ~ , ± ti ' ~ ~ _ „ ~ ~ .t:,~ i'. C~ ~ ' s ' ' r ' ' ~ ` Deputy Registrar = j Date Issued ; . x~ :..j''% ..T. ~ rtrR~ ~ •~'~:t7~ ~ t,,~•"j % :~-}1~{~• ~ / ~ ' f s~ ~ t~7ARidING: Not valid unless raised seal af ~he'- ~MSION OF VITAL STATISTICS, POLK COIIi~TY ~ HEAIlFH DEPARTMENT is affixedo U~~~~j~~ ~~Q~ _ ~.?~..V V b , - ~ - - - - - - - - ~ K ~ ~ } . ~ ~ ~ ~ ~ y~~~ r ~ ~~°a~~'.~+~,"~, J _ ~a . .