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HomeMy WebLinkAbout1013 ~ ~i . . ~ ~ 286082 ~ - . ~ = CERTIFICATE OF DEATH . . ~tp+~lrewl o~ 1 ~ra~lb ~ao ~c~u~.ililalirt $rnice's ~ ~'TATi FIL[ NO. - ~~v~w?~ c~ ~n ~~.n~ F L O R I D A i~iE. O! ?2tN7 IN '~'°~~~"~`•'~`s REGISTRAR•'S NO. 26~ ?SLitA~NT INK r.oa~ ~•s~ ~SEI( t1AiE Of OfAT„ ~•c..~•, ~tu~ fif 1'1Ji00[ FOl DE~fwSED-++•wf ~t ~F. Fl ~Y 11~ 1974 ~ asmctw~a , Fit3BEFrI' H. HORC~IIQSS RwCE .•••n. Kecw. •:•i~+c... w~..., AGE- ~r ••c~• ~ ~we¦ ~ a.. DwTE Of N~Tl1 ~+o+e». ~COW~TY Oi Dfw:H ~~c_ ~sr~ ~+~4~. lw~aw~~s~•~fi~.os . wn ~.ou~s :~w. n"b~~11~21 ~ 1~~. ~ ~~ii11:+ is' , ! .r• ~y :k ~ ~RY. TO~. O~ t TWr+ Oi OfwtH ..uoa t~n ~..w NOSMTAI W OTh~f~ MS7ITUTIW~- ~r ror e.r~, am a.r~~ .w ...y~~ ~ b O UZ t s~~u.. ,n o~ w n FOKL' PIIIi~. YES 1 r~ FO.qI" P~E: T~'~RIAL H~6PITAL~ ---r - ~ ~ ~ ~ STAiE OF WM ~ «Ot w ~.s ~+u~ {GTUEN OF v:nwT COu'HTi- Y~w?tt~ED. ~+tvER wtA[L~EO. ~S•JIVNNG S~ONSE ~v ~n~. 4M .~~t,. w~+1 ~ ; Ca~~7~? coww. ~ ~ U . S . A . ~ ~"w~c~o ~ ~ ; H4~1E2~2EI' Fi~dIC~II{ISS ; ~s~....w...u ~ ---!:e ;u . w.~til WC~~YD ~~wt SECi:aTY wuWf~ ' uWwl OCN?wi~Or+ ,c..~ a..z c. wu. oa.~ aw.•w •es~ o~ !Rtr1O Of WSr~ESS Ot ~WiiSTRY + " I `°~a"le~s"~ zsar 258-34-6932 ,~y ~'v~ W.R. GR~ O0. _.,,~~,:a... .etao.u wN.e wa.w c~n .~.rs STeEfi ~u+D ?.Iw~k~ .~ss.w. aFiWEwCf-SGtf COUr+ir UT11, TOWN. ~t ~OC~1~0++ 1 ;.v~a•. •a w w FLORID~, ,,,ST. Y~7CIE i,k FUF.T PIEE~.'E ' YES 1906 RO~L PAI~~i D?~~ Fwir.Ea-r+.?vf ~,n+ ~ +wou uar wWtMEt-wu.Dir~ N~+rF ~w~ r , t.J~J•~i`711+ i\J1~..i7i~iJJ • ~t~ Cli~i.~"1F+ 1'11L~~Y'fl`i il ItJO~MAt~i-NwMi /rALL~`~G A7ii[~i ~f~Y~t M~~.D. .0., 4r• O~ ~orr, s~.rl. [r~ p~',S N~R~.T F;~CISS 1906 RG~1L PAT1~: DRIVE FT. P~ F7A 33450 ....o.r.,~ ~ iwi7 D(wM wwS UUSEO W: ifti1:~ Gen:r Onf CxUSf IiR LLVf iQt te~ ~1~ ~+r0 ic:: ~er.~~w o+i~~ u•rw r.rwn :.ru / i t., i. ~ ~ ~l~fl ~?L' . ~ { VOwDU~o«), u . c. c.r~ •.u t0 i6) ~ . , .~~w..n c.~s~ :o~. S wt ro. p .i .~co»xow ~ a ' r.{ ar•r~.:.+~ u«oa~- ~ ~ : .J \I~M6 C Yfl ~~ft • i , i ~ ~ [ , c~ln~~ co~sea..t• ~ +o w,w wr .+sr n..•w .o c. - . w. AUTOiS'I • tF YfS ~..e . .a..as cc»- ~ /AiT 4 OTnfs S~Gw?I•.C T f ' T~ s.a~~ia a~+~~.:.:w~ u.~se ~ `7' ~ l'~11~i.1~1 G~ff" j ~ " /~.•'1, 1~~~ t ~ ! ' ' i ~ ' a.i w~:.iDE.vY. S::i~~Jf is E~F Y:X: +q+rw. a. . t•~ ~ 'hCW~ ~ MOW tNIUtY OCCill~i ••*~i ...ruu o~ «~in r•~~ . M r~~t .~t~ ~ > M:.+~:GDi; G2 YA".1ETEtY.AED ' c»...~A ~ ~.i '•7a ra ~ ::e iN'.::RY Ai WO~K ~7~wCE O? wi~r., .o..~.•••~. s..e~., .~JO. I:OCAi/CN ~ s»ur W~.~ wo.. t.n O~ tOrr. sr•-e. - .flfC.rt ~ll W MO~ !OMK~ wOG.IK. ~YeC.n1 - x. ':r '~y , _ .o-.rR w. .u. ~ ~..,w o.. ,e., ..u s.. .,..e w ~ osio.o ..or .y~ ot.r.. OCCV~~lD ,..i ...ce. ~.e CEtTIf~CAi~ON- ~ ~ +O+rw • ~ ~ow .rrf' Oy.a. +..ar~ ^ c•*~. .w. ~o +t ~esr .ti.fK~.~: j~ ~ O ,LL w ...b_.~w~. .sst~xo r..e j ' ~~:,.~E., .o_ ~~2_4~6~_- 5~ /74 t~,. ~ ~ l+~ ro :..i c.w:s: s'•:ea .«f aueai.. ~.a •.o..a.~c~o w.a Cf~T~f1UTiGr-~tEJ Etwwr:fa Qi CG;G~Ei. a-~e a.ra u. :w ..o.~ w.w. ,,,o.,~. w~ .u• .wr~ ~t~rw~f4+ O' M ~00~ ~W/O~ T.~! .MllT4~+0~.. C~~'•+0~•. ! ' A~. a'~m OCC~~a[O O~ W O~Tf u~0 OY! p M UYSI~i~ ar.-tJ ~ 7~, M ' - - - au ca DwtE S;G~fD a....w~ GERTtF:Fi-+v~Mf mn a. S.Gav . ~ u i W ~ ocask i1D _ 5/17 74 , ~Z~L _Tl__ O~--Y ~ ~`~-`~'•1 Z.- •u.yuyG +CJTESS-CF~7.~tEl ~ tx 7 al.rtAi. CRfMAi~Ot{ iFMOVAI CEMEtE:Y G~ :Gf~NtTJ3Y-narl" :C/~wT1(',r. c.n o~ so~+ s..•a : (g,gc~val) i~.? EI,F~FGSF'~~R C,~'~'PERY GEOFGIA ~ . DA7E ..~wrw. o~s, n.a~ ~fV~v_ nGMi-'.s.v~ a~D aDJiFSS . s:~~u o~ ~...a ~.o . cm w~or... ir.r~. [~r ~ r„ 5-14-74 tn. ~~•~`~I. f'~I`IE g0i N.7th St. FT. PIERCE FIA 33~50 v. 5. s612 fu+[.a..~ . /Gri?ru:E tio~s~~•.e-sGnw:;q~ o.n ttu~~+~ sr aou. u:..u:.a ~~E"a/1VG~~''1~~~ r~•* i~j!''~~-. /1rs.. t'~ i7w ..r.~ ~ 2t7 ~74 R~r.19T0 ~ fItEO t~K'? `•~~v~QEO , ' ~7 WG~'~ .OUNtY flA• ~ _ i s` ~ nttaoy ooet~fy mis to oa a tni~ anq eorreer eopY of inee wee~ C! Rq F COURT " : d nn file in tho 5~. luc~e Gountv He~!~ Duoan- ~ . R~istrors recor acr~~n; :E ~ m~r:t st Fort Pierce, F!o?fd~• ~~A : { uf tha St. l.x?s ~uL 5 1 07 PN'1~l - ~ (yy~~n:ny: tvot va+:d unless r~~ - ~ - - . _ Gpunty Heaith ~epartment is affixe.i.) M. D. 286082 ~ -J~ ` = . ~ N. D. MIIIER, ~ . County Hi.a~th Off~csr d. tna+t Ro~~stra~ ' ~_~/-?4/ _ . ~J.~P. 0.,,,a l,ocal Rr~~stre~ . soa%229 P~~~ 10 _ - - ~ ~ _a ~ ~ ~ ~ .i ~r: _ - ~ x-~ _ ~ ~