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HomeMy WebLinkAbout2762 t~ ) 28 REC1~[~ Ne~ 11 12 ~8 PH'~ I ! ~ . ~,,;\G+ ~ P~ ~~,I' M E~ T ~ ~ TY H E A LT ~~3~ r-~. A I~'~~~ ~ O U O R . N,~.~~ ~f! WtfT CENTRAI ~OUIEVARO • fOfTOFfICE ~OX ~lq • TEt.~ '1~1~i11 ~ O~AM~O. a~~QA !l~01 ~ ~ ~ J ~ ~ ` IFICATE OF DEATH • ~TSS1.4S ~ ~ CERT pep~el.,e.~ .t ek.hl~ .d R~I~.b11nNr.e S~.dee. srATt M~s ao. ` orv~~~~?~ F L O R I D A nca~sr~~n•• No. . ~ • V ~ •~E~_N~[ ~Ml1 ~»N~ l~{ Sfx DAIf ~f ~EA1M ~ rOMO. N~, Mu ~ , Jahn Jose Pais e ~ . ~ U?CE .rrw. iaow. ur~icu~ wur. AffE-u» wee~ ~+~u wot~ DATE Of MR7N ~.wM. w*. C01R~t11 Oi OEA1M • - ~ ~a. ~ sncr~ i ~nr~. ~~ws i ros. ~?n roiw~ NOV 19~ t~- ? . • White s.. ~ ~ . ~ ` ~ ~ A MYN !M~ ~1Mq A~ ~ IM MO? M~11M~. OM ~IM~t ~1~ MM~N 1 • 1NCMt N~ O~ MO ~ . Orl~ando Yea Naval Hos ital ~ STATE Of ~M1N ~ a wot w~ ~.s.~_. .are G112@1 Of MniAT C01RtfRV MAttlE~. !lvER MA~EO. SURVNNG S~OUSE ~ r ww. one r~4w. ww ~ ~ ' ~q~~ ~ ~ rKn ~ ' ~ Pennsylvania U5A n. ~ Ina Mae Gillin : SOfJAI SEil/bil? MJWE~ ~,~~w~Aae~r a. ai••~ a.wc w~w wwra roa a RND Of M!SlESS OR INDUSiRY d # „ 241~48-0061 n... 1~4ilit ~s. 6overnment ~ ~ ' • RESIDENCE-SiAtE C011Nf1t G1t. TOWN, a lOGi10N •~~w c~r ~wwf ST~EEt . ~wcw~ ns o~ Mo y Florida ~o Or e Qac~lando ' ~a. No ~w 06 Do o Avenue ~ fAi11E!-NM~f r~ . r~oae u~si MOTlER-MADEN NAAIE rwsf . rwe~~ ~ : William Paisle N. • . So a Gi 1 l i t~ . s s ~ INIORMIwI-NAME MA~NG ADO~ESS ~N~tt~ a~.r.~. «o., aA p w.~n, we.. Mrs. Ina Nae Pai61e wife Doarado Avanwe OrlBUxio Fl.orida 2 3 rner oEw1M wns C~uSE~ ~r: t~+ d+tr a+E dusE rp~ tnE rot Irl. AL ~ kll ~ w~.aM oMU+ uw w~. ~ w I L ~ . , ST. LUCtE ~f~UNTY FIA. hl ~ ' , . - j LEF.r. :JIT C3U - RFC^.Rr i cor~~no«s. u ~w.. ' .r~cw o•n use a (~l f ~ Irr~N~r! cl~tlft 101. N1~ t0. M~f ~(OM!! O~: ~ ` ~7 i t st~nwo ~¦e vr~n- • J~ 1S 1 ~ ~ , ~nMe c~~u i•sr f kl ?ART OTl~t SK~sNrKAH1 COf'b111ONS: CONMI~OM! COMMY1w0 ~O Ma~w W1 MO~ ~l11~nf ~O 4rf! WrlM w r.n ~ r~ A11fCK1l i tES ~ff! ~IM~IMO co~ ~ ~n~ o~ Mo~ . a~ea~ w anuwrwa uww~ d ~ p ~t~tM ~ Arteriasclerotic heart disease No ' ~ ~ ra~m. w~ Now ~N~utr oeewdttu ~ e~.n..~.w.e a u+wr.. N...n ~ w..n a, aer ~ ~ ~ Ot IMIDEIERMINED i ~ lk. M. lli. S~ ~ ~HIURr AT WOR1C K/1CE Of NIU~ •T Mow. rur, sr~eer. acwn. IOCATIOfi ~ sma o~ ~_r.~. wo.. an o~ ~o~, a.~e ~ ~ tfMCtA M w01 OI~K! MM-.tK. ~Y4C~1 • ~ ~ !M. ~s CERt1i1GT~Ot1- .+o.wM w~ .e~ ra+M wr nu ue usr s~.. wr/ une ow ~«eiao .w .n. uw oenm occw~eo ~e n~a. ou we j ~MSKI~M. ~~M M~ 1~~~ ~00'? ~/1N Ot~lw. IwpM/ O~~I. uy. ~O Mt ~!!T ~ .m.wee n~e ~p ],3 19'J1 t n~. SeP ~ ~~1 tlc `~p 11r. ~(1 tN. ~ ? waneea. wt n~ wcewsao~w.. 'i p ew~ea~su+n. CEtiMIGT10N-?wEOKIU E1tAM~iER OR CO~ONER: on n~e ~.s~s a me ww a oe.w me aceee.n ~s noNOiw~cw ew eur...non a w ws~ ue/w aw rnnsnwno.~. r+ a~«o••. e~r . a•~ wow . 3 oe~w~ occu~eo o.~ s~e w~[ we we ~o nn uusea~ s~~no. ~ ~ ' ~ ~ A D , b~W~ ~ CERTIfIER-NAMf ~~e o~ ~n ~ tdICHAEL IEPINSON LT.MC USN ~.1~ ~ MARNG wDORESi-eERilfEt s~ra a...o. aue m , - t71 , WRIAI. QEMATIOM. ~EMOVAI R11 OR ClEMA10RY- • IOCAi1011 . dt1 p~O~+M !L?1! 'f ~ wltnr ~ • • -~w ftemo bur a ~ a ~ Pe lvania ~i OAtE ~ ro.~~, w~, eui HINERAI MOME-NAJNE AND AOO~ESS ~ srna o~ ~a.~. Mo., trtr o~ wwN, fr~n, tn ~ Se . 15 1 1 . Col Flane al Hame . 2 Ol Ccn~+ Road Orla~rdc Fl ~~~3260b ~ ruNeu~ orucT m ' - . . ~~~r ' ~ _ _ • CERTIFIED COPY ~ I hereby certify the above to be a true and correct copy of ~ tbe I.bc.~tl Registrar's ~ record on file in the Ornnge County Healtb Depertoant~ OrLnd~, _ . \ ...,..'r~~`. . . - . ~r~ : ~ . .O ~ ' ~y ~~~C~,~,~C ~ - . . " , . , , , ° . ~s , Coui?ty Health Ofli~Car*and Loc~l Regi~trar ~ ; _ / . « ~ ~ ~ „ s f " ` . ; 3 . RECORDED & RECORD VERIFIE~ • ~ 6 1971 ~.~%~-~I,~( u` ° . F ; ' ~ ~ SEP 1 . ~ . ~ Cierlc of - ~ ; ~ R ~C° ~j Circuit Court; Orange Ca., fla. ~pu~t~~t= r i ~ 600K~.~?O PACEIG~t • ' ~ ~ ARIiIMC: Not valid unlea• riised seal of the Osengi~ ~ ~ ,County Haalth Departsent is affixed. . ~ k . • . _ . . _ _ _ . . . ~ . _ _ ~ . y~" i, . ~H-~`~~ ~,a~a. ~ ~ ^ ~ - 3 .'~'.p,i`~ .a~''s tY~" ~ ^ m . < ~ _ _ ~~~G . _ . ~~..,~r . . . ~