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HomeMy WebLinkAbout2574 ~ . • r--- " c:ERTIFICATE OF DEATH . tTATt ?IL[ NO. DepaHn.ewt ~1 IIra1~6 .~d R.b,.L;l~~~u.~ G~~ich ~ !11\'1>KW (N Ilf ~I ~11 F L O R I D A REGI6TRAN•i NQ.r tv?E. OR rnNr ~t~MANlNT INK ~~Ow1 ~~f~ S[ll CA1E 0? CEAIH ~ rOwtw, Y~~, ~t~~ ~ O SEO-~+M~[ •'~U s~E .•~~~eo~ ~a `~.~S~~J~ ~ Jariuar5? 1~F 197~ - atnvaa~s ~ SIDI~C FEI~MA?J t Male + RACt .•m. wc~o. ••uK.N »w~.», wGE-~.f~ v.o~• ~.e.~ u•a~~ ~ e,. O~TE O! ~~RM ~•~Oam, e~r. COUNT~ W Of~TM ~<~r.e.. n~.u~ +of. w.~ Mov~~ ~ •K. ~ 20 191 t Sroward • i~Ihite b2 A w ~ I~ov. - ~ IOwN. OR lOCwi10N Or OEwiM M+s~o~ cm u..~n HOS~IiAI O~ O:~Et l~S1liUilON-NAME 11/ IQI 1M UTM~. av~ s~uu .ne ..uw~~ ~ , ^ ( ~ snca. •e~ o~ .a ~ Plantation• Yes Plantation General Hospital ~ SURVIVNG S~OUSE ~ u.ru~. one .nee.. wa.e ~ STAIE Oi uttM ~ u~o~ v.s..., Q712En O? v+?u~i CWr+iar ~~~EO. t+EVER w~t2~EC. cow~ ~ ~ wIDO O. OtvQRCE~ ~ srecr. ~ , New York U.S.A. 2~arried n F~i.eda Broberg .~~~e c~u~uo ~CUt~iY NUWER USU~?l OCCU~?~M~!! ~w~e a..e a ~a.. oo»~ wu.w ro~+ a KWO Of WSR~ESS OR ItxTUSTIY U~~D. Y OI~M wu~w un. e.i~ u ue~a ~ . «c~u~o w ~ ACCO~IiIt'rltlti q1 ACCO1lI1til1'1P Iti)TfJTw. am „ 066- 03- 937~+ tL - eiYDf.K! ~lW~t u~4a ta* u..~n S1tEE1 iu+D MUM~ER ,o..n~a.~ RES~CENCE-Sf~TE COUNiV utr, tow++. ot tou?tior+ .es w.a Florida ~n Broward ~k Lauderh311 Yes 1334 N.W. ~3 Avenue us~ MOiMER-MAIOEN N.UME ~NU r'~~ V'1' . fATMER-N~w~E ~us~ ' Jose~ F~eldman Sarah Schoen.*e2d ~s. IWOtM~Nt-r~~E w?1lwG ~OGRESS ~unn w~.ce. »o., cmr o~ •o..., u.n. :r~ David Fl~ldm~n 24 Flower Road • Valley Stream, New York ENiE~I Wur ONE GuSE ?ER tu+E ~OR (e~ (s1 ~w0 k)) ~uirea,. o.~ii~i ..ta~ei. /AtT pEATM Wh3 UUSEO ~T: ~ u wrea.n uuu . M~ Acute Anterior Wall I~yocardial Irifar~tion ~O~'s : ~ • • w K~ ~ IIT11fl10W11 ' ~o««.~oMs. e L3ke Coronary Artery Disease . wrKw c~r~ usc w 1 1 ~ ~r.eo~ue e.uu ~m. ~~o. «.s . ew~uoui..ct a: tf~tlMG 1M( YNDl~- ~ UIM6 C?YS! ~~fT ' IUlT01Sr li 1fF5 +~eie ~~..owes e: ' ~ARi OiHER SK,t~tIfK/WT CONWTIONS= eo..ana+s eo.n~~~un..a w ee•n~ w~ .a~ nuns w uwu a~rtr ~ur ~ a~ ~ns o.T•o~ a oiiw oueuu~~MC u. ~ - IA. ~M ~w~oW, 1 KUDEN7, SilK~OE Ot Ow ~ra~», a?t,rt~~~ l10tM HOW IHIURY OCCUtREO tlMlt ~ufu~! O~ 11uY~t /~a 1 W/wtI11~ /1fY 1q~- ~6E, pR WOE1EWtnEO ih M. 101 IWURY AT WORK hACE OF WN1RY.~ rore. r•u.,. sn[e~, rwnw~. IOCAt10N ~ snt~ o~ e_~_o. MO., tm o~ ro.w, sr~R ~ If1fGA tlt M a0! OMK! MDG.,/K. ~fMC~I~ ' ~ ~ ~ ~~~~i~_ ~TM ~r RV ~W wND YSf S~W MW/M~~ llM ON ~ WO/O+u ~+Ot v~M ?M! DEwiN OtCU~~ED ~t Mt hK~. W'- ~ •~S~C~wr+: TO ro..m wr ~ ~ooT •rrt~ oe.r... ~w~~~ o.n. •~o. ~e • y 1. 1~ ~I~ 1 Zlt. 1 1~ 7~ ~d = 1 Os rr ~.rrv.ita;l. ~ 1~RlMOfD Mt ~1~1 O t0 ME 4uSt~3~ !t~' ~ '~il Ot[/~flD ~~0+ ( CE~iIf1Gt~QN-ME~Kwt EX~wi?+ER O~ COi?O~+ER. a. ~we a•a~s d ot wow a a.u. ~i eiceu..i r•s ~eo..ou..ceo oi.o .,o~+M e?~ nu wou~ ea~rw.n0+ O~ TME ~OO~ wHD/M ME w.Ift~G•AOM. ua r~ OrwWu. ; ~ ~ d OCCUnH O~ IM O~t! u~0 OYE q Mt 4vSl~f/ fuiFO. = K~. , ~ . ~ar CERTlfiEt-NM~E ~nr[ o~ .~w~ S U~ wwrt w~ ne ~AiE SIGNED ~•+o~.n.. o.~, •a.~ t ~1--~. :~Tar.uary 16,19? ` Orlando~in M.D. ~ 3~~~ 3 AtARtriG wDORE55-CERtiFIfR s~ne~ o~..o. e n oe .o+~ sr•n 6S0 N. State ~d. '~r7 ~la~~ tion Florid~ ~ ~Uk1Al. CtEAMiION. REMOVAI CfMETERY OR CiFMATOQY-NAME IOCATIOPI 4T7 O~ tOww Si~lt 1 YNY? ~ ~0~~ i, ,N Burial Mt. Sinai Cemetery n~. Miami, ~ ~ OAiE i..o..i.r, w+. •w. fUNEpAI MON!E-NAME ANO AD(MfSS ~ sunr o~ ~.r.o. ..o., u~+ w~o.+.., s~.fe. :~r ~ ' ~r ,y JanuarY 16, 197~ :~.~~ID~ 2~4. C:3~.PEL 164Q0 N.E. 19 Ave. • N. Miami Bch., Florid ~ i f j \ J. *612 iUNffiA}OIREGTOR-SK~AtYif ~ J REGISTRAR-yGt..~fUDE O~TE [tCErvED tt tOC~I iiG~Sit~l : j ~ ~ ~ ~ ~.~j~ev.1970 lts~ j rr~tj~ t' f ! =s=l~.~. ~w ~~~!~l7 ~`.~~~~~c~~~ '~__~.•`~~?n' ts~ ~ti~~J. /!o ~~>J ~ ~r l - _ . - J~ : , ~ ~a..._ ~ o ~~;;~~~~'1 r~` J,~~. CERTIFIED COPY , r ~ - ~ t' - ! ~ ~ I hereby,~eit$€y~;th~ ~a~o~'~ to be a true and correct copy of the Local ~ Registr25~rrs ~~orrti ~dz{`• f~~.'.in the Broward County Health Department at , ~ Fort Lat~d~erdalg,,,,_,~lorida:' ' . . . ~ ; ~ - c; ~ (Warning~ •.?f~,o~~~~d~~~~~~s raised seal of the Broward County Health :.1:~3`~~d~•i~~CPfixed.) ~ , ~ afi~ L : . . ' ~ ~ C nty Health Off' er and Local Registrar ~ . ~ 6-13-?4 . ~ Deputy cal Re~istrar ~ _ _ ~ t ~ ~ ~ ~~turn to: ~ ~ ~ ~ i t.i.f ~ • ' '.)~i , h? ?eRKELI.STRAUSS 5~ li: . ~.c ~ ~ 8ENJAMIN, P.A. ~ _ ~ _-*pRNEVSAT lAW ~ ' : ; E 16Ind STREET ~ ~ ~ ~.~;a7M M~AMI BEACN ~r e,~i ~ = ~ORiDA 33/62 l11N 3, O~~ ~f ~ ~ sooK 228 ~A~E2569 ~ e <~~~„,~~+u, _ _ ^4 ~ . ~ - . _ = : ~ ~~~e`~ _