HomeMy WebLinkAbout2040 ~ i
~ CERTIFICA`TE OF DEATH
Dep~~t~ewt ~1 liealtl~ a~ Re{M~Nalive $erviaes STATE Fiti NO.
? MV~SION OF HF~UH F b O R I D A REQ~srRwa•s NO. g 3~[
rr~E. Ot ?RIN7 IH
:~4aMA7~[NT IMK ~CEI?SEO-NrwE a+ar +waa us~ SEX OATE Of DEAM ~roN~., ~wr, •e.~~
SEi %U~YIOOi fOt
~srenaars , ~ CHARLES WAD6WORTH MACFARLAN t- ~
RwCE waie, «iaw. ~wucu~ wau.. AGf-t~~r w~a~ ~ re.~ w.ot~ ~ w~ *O'A~TE W WM ~••owiM, w~, ~plltlfY OEwM
ett. tYfcusl tMM~~1~U~s1 rOS. ~?'s ~OY~f +~M• j~ *~e
~~-9c ~ White 67 s~ . Au 20 L~
I CIn, TOwN. OR la7CwT10N DEwTN ..sa~ cm ~rn MOSMtM OR ATMQ M?S ~Mb+'~-?~E "Ot ~'"'~a, bw! !Ir!!t u0 ~+W+~f~ 1
~ irKUr ~ef O~ ••o
Lehigh Acres No Lehi h Acres General Hos ital
wN~T CfriMViRtl MA~RIEO. IJEVEt MARR:fC~, SURrIrING S~OIlSE ~a ~rrr. sne wotN ~~w ~
SiAiE ~X i~iin ~ M MOt tw c~.t.:.. ~ta: lT~3~! C~ WIDO~MED. DIMaRCED ~ YKlnl
~pVnttl
~,~.,„,.,,K~ New York U.S.A. „ Marzied ICathleen Hu son
~.e.e oece~ue ~uLL SiCWtiY NuMtER tlSWl OCNIA~ION ~awt ir+s o~ .~wa ooMe o~wu.~. rost or KINO OF NlSM1E55 OR uiDUSTRY
l~.f]. N OII.M ww~w~c we, M~+ Y ~lWfD~
ecc~~~eaw ~~059-O1-8663~r~? u.. Purchasin A ent Consolidated Edison -
~.ST~:4:~p~r G~
.~s:x..ce ~tro.e Qfr, towN. OZ IOCwT10N «+s~a cRr trrts siREEi ANO NtWiE~
c~~+swr._ ItESIpEHCE- ~TE COUNiV ~wun rES w w
Florida ,o. Lee ~k Lehi h Acres ~u: No ~w. 186 A ch t
fATnER-Nw.i r~nt - rwae us* MOTMEf-AMDfM NAME hnr rwae -
" ,s. Charles E. Macfarland u. Ma Kell
INtORMI~t~i-~+M~F MI?I~NG ADGRESS ~s~ea oe ~.r.p. w.. c~n o~ ~ovn+. ~.ie, :r~
Kathleen Macfarland ~n 186 Archer St . Lehi h cre ~ M.u
rwi~ DE~?:N wAS uwSEa ~v: !ErrtEr OMtr a+E c~?tJSE rtR u+E to~ (ul (bb ~ND kA a~..n.. o..ser ee.u~
1s. ~w.a n uw~ i / ~ / ~ •t ~l ~ /•_d^.
lal c./,' ir C. t4~-~ ~.~lltJ' ~ Ls%u.d '~:l~'.~t~r`s'TLo a.
co~~n.o.s. u .rr, • ( ~jlG[/f'~If~-~ ~ ll/..0
•¦~cM c.ve .~a[ ro tp)
~rrEM~TI C~YSt io/, ~ p, p~ ~y ~~pwfepyl.K[ p: ~
sr~n..c ~we ~wota J/' ~~/J l ,/r
~twc t.YU t~st / 1• (r ~'/~C~4~'~ , •
y (c~ ~ ~
wUtOt~Y IF tlES we~e nwawcs cow-
PwRi OiMER SIG~+~KwNT CON4R1JN5: co.ro.nws cawMU~~ w se.w._w~ Mor uno so u e c~x w r••r ~ ai ~ns 4~~~ s~aaee ~w e~*e~.r•ww cwu
p~ `(~1M
' ~ Q~,,..u~;~ t~%t/.j.t~r.i • lcti. ~~L%sT ~ l~f/J ~n
r e..~ n
O
U t M O
w I t
~ N l R 1 1 O~ t u R R E D wn~ a wwn ~M rur ~ o~ r~n u, nw ~~f
~ 1?~+bsbM ACG9~NT. D 02 A 7
1 1
i Y t ?M. W ~
~ p~ tlMJETEIMUa?O
i ~ ~ 77t. M. 7~ .
e
't /~tr, StftlT. /wt70~+. 1~A71QN 1 fnttt O~ ~.{.O. MO.~ C~if O! i0`rN, St~Q 1
~ i ~ncRn ni or~i.o~ owrctEwno. r f'K~
n
i
KI
„o,.n, w. ,w u+o uu s. ~ u~+e o.. ~ o~o w~~,+rc~+ w~e ot~~ottuae[o ~we ~?w
~
Ks~
CfRfiFtCwiiON- ro-nN wt reu ~q,.m r nu soo~
~ ~ ~ ~
fMTS~C4~N: -s 9 ' J~y p wr R.~w~eact. ore
~ ~n~..ao ~rt . ~ T~~y ~ ~ iJ ~S iti. .y / ~ n~- lte. ~ ~a, to w~c uusea~ v.~ts.
7!t MClaNO ~Wr ( , tw! OKfOfwt r~3 MOwW~O OE~O .
GERWIUTqtV-~iCAt MMt+ER OR COtOMER: a+ nu a~ s c~ ~~e «ow a oe• .~wiw w^ n•~ •o,r~
' ........,b.. « .K~ ....,,.~.,,b~. a . ; ~ y 1^ r,c -
•ta ~rM Ottune~ Or~ ~.e O.a wo oa +o tw[ uwseqi s~•*~a• M t71.
SK,NATUrtE eewn w mu wTE S ~.a+•? o..,~e~~~
CNT~HER-nM~F mn o~ rawn i/G~/ ~ ~ ~ ~ • ~ ~ '
Peter Sansone , M. D. •m ,~.ri •
s+reer oa ~.~.a. w. tm a~wM
w,,?wc-~ss-cf.:n~r Medical ent Floridn 33936
' -
EMETERIf OR CREMAiO(nf-N4MF ~tOCA C~*'? Oa ~O~r.. su~*t
~~tAt. GRfMAT10N. ~MAVAI .
~s.K . Lehi h Acres Florida
2~~ ~urial x~ Lee Hemorial Pc~?rk ~k.
O~tE ~..o..~~, w•, •u~i fUnER~I M.W~E-N~INE ~r+'J ~?DDiESS ~ sne[T oe ~.~.e_ .ro., tmr w w.n+, s~~re, :u ~
~~u 27, 1973 n..Farley Funeral Home,1105 Lee Blvd. ,Lehigh Acres,Fla. 33g35
v. S. f612 f~~ ~-~"u o~:c aeen o tr ioewt ~eo:sru~
REGs~f~TwR- ~ _ i ~ ~J`?
F. e v. 19'0 ~<_e:~ ~i. ~L.. C~ ri1 J~f.fl~+f ~ ~
~ -
/
•
~
~ I heieby certify the above to be a true and correct copy of the local
~ I?zgiatrar's record on file in the office of the Lee County Health Depa~tm~r_t
at Fort biyers, Florida.
~
.
- (;~7F~R~iZ1VG: A~Br~j~ unless raised seal of the LEE COUNTY HEALTH D£PARTI?iENT
~ s a f f i `~.:».,;•~'?.i .
: x`~,± - ~ A~ Y~t
.
i / ` ' t ~
~ . • ~ J!;'
~ • ~ ~ . . /
S : ~'pie1. ~ . ~ ~ L--~ ' l fIIED AHU N~CORpED
E ; :~f
~ • . ~ ~ - ~ r / ' ~t-<~ G~ _ ~if~f~-~iT. LUCIE C~UHT1f fLA.
- ~ ~ . '2. ~-i •
_ . ~ = -1 _'~..g - ~
~ t~~u~,, ~ ounty Hral~th Officer and ocal Reg~~ ~,iG~~COURT
' v ; ~~•~y' qEr~`F^ V~( ~ iED
.
L ~ , r-
- ti
, ~,.F , ~ 9 06 AN'1~1
~ T ~ Auc 11
~ J~ity 2?, ~.973 Attested- ~
. •
- j~.;r_~ Deputy Reg _ strar ~ ~~~'~'7~
o R ~ ~~cr ~Q -
~ ~ _ - h
.
r -
ti~~,~;~~..~x~~.~,~~_i~~ _ ~ _ ,
~ `