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HomeMy WebLinkAbout1446 _ 1 . CERTIFICATE OF DEATH ~ Dep~rlmenl Ikdtl? ~ad Re1~ab~l~~atire $enkw fTATt FILt MO. ~ u~.~R~~w~~.,~~~~ FLORIDA tr?f. Gt 1tl~i1 .H pEG1~RAR•! ?t0. ~ttMAMtN? INK ~:q~ r.eae a•st SEk OA/E Of OEAM •+uw~~, o~r, ~ CfCEwSED-N~wE SEf NN10100[ fpt ~ wsn,~a.s , ,•;ARJOR3E Fr Aiti~~S ~VAnS : Fem31e j, JuZ,y 2? ~ 1° ~ ~ •to~r+rr or eurn wl4W. ~rl~K~w was.+, wGE-i•a~ ~'e•~ ~•"a~ ~ o~T O~iE Oi ~itM c~~, RwCE .wn. --,--y- - .j.~ ~ nc ~ s?ecrs ~ a~:¦w. ~.tus ~ +OS c.n +ou.f ; .u~. ~ :~hite 51 ~ i T. Yu~. 5~ 1922 i~roLtiard . CRY. IOMM. O~ IOCA~l0~1 O~ OEATM rq~of (m tras MOSrITAI OR O:f1~~ tiSiliUilON-NAMf ~ N w~ e~*rl~. ~:~.e s~~t~+ ~w ~wwx ~ / sncu. .n o~ ..o pi antati c~n es ~octer' ~ Genera? hospital STATE O~ t~RM .u Mo* +M v s•.. «.ri UtREN Oi vY?uT COlIN1Rr ~R1ED. ~+EYER Mwlt~!ED. SlNVNNG SlOIiSE ~M Y/N~. GF~ r.~oe« ww. cw..~s~ wi00wED. W;~OKfO~vecr.~ n.«..~ . I:'.a i ne . U. S. A. i~ :~:arr ie c _ G? e n~~~ans ..eu oeci•s~s ~ut SfCU~tt t~fWER USU~I OCCIJrAT10tr ~ a.i ewo o~ •wea oo..e ew~.w. ..oir or RliO Of WSwESS OR wWSR~ 1D • a•s~ rvawc iNt, at++ u~tnao ~ ou,nitc sw ~~S'~•~.~~.~ 004-18- 86~A House~vife „ ~vn .orr.e ~u.oe»:t ~troat r.fq un ~r~n ST~(ET MID NU/+lE~ .n.as~o... RES~DEKCE-St~TE COUNft CIf1I. lOwN. OR IOCATION « p, ~.ot ~ 57 S ~arl ite L'~'~ • i ~u eS ,~a ^ra ' l n~~ ~arL- ~•.rl.orida ~y.•.artin ~kJensen ~eac:~ FA!?tER-nuvE ~~a~ rwxt us~ MOit~El-MntDfH N~ME r~ ..•aae us~ ts =inr...~. It~ ~"~C '3C~ =aUf`~'?? 1n INFORMANT-NAMF MAK7tK+ AOGiFSS ~S71![i O~ ~.t.0- W. Crt~ O~ rJ~~, s~•!t. Srr ~e,~C t' , = i a 1 • Lot Y 57 StarZite ~'ra~ ler ~ar'K, ~°r.~r~~ ' iH . . i ?ARi pf~~ wn5 GUSE~ [ErrtER Orrtr OriE UUSE ?ff /Ir+E FO~ (o~, (e), w?+~J «/j ~r.w~.+nrt e.at y ~ltrllN OMSlt ~wO OI~SM : u. rr[iuR C~YSt - t•~ Il~ .(~y Qt ~L, 'y{ • ~N I ~s • wuow..:t coMwno.s. u ..n. ~ ~ , / ~ ~ L l rw~Cw G~r~ ¦~f! t0 ~bl • r L' ~ /C~ ~ ~~~i / / "L / i.rioute c.vs~ w~, aue . co~uoue.~y.oi~ ~ / J~ f1~i1Md iM~ YMOl~- I~~MG CaY~t 1~11 / C. • / ~ l1 ~ ' ~ / ' - • ~ • ~ ~ 1~ ~ ~ fART 11, iHER S1Gt~MKwr~T C` ~~ONS' COMPAOMS COOW1/pMG K7 OI~M ~V[ MO au~nn w c.uu e~e.. rur .~a~ ~~Y ~fi reee ~~uu,+os ea+- ~ ~ ~.~s w ..o: yw~ea ~M wreuu•.we uvse r~ _ • l) ~j/j. ~ ~ ~ -',C ~i ~ t k .L - •`f:s:~frc- t~i - Y H. o ~ ~ e~.z~ ~ '~?ey1~ ~1p~'Wiw~DO! OA E N1UR~ ~n0~+*w. n?~. ~e~~ NOUR M01K N1VR1 OCCUtlEO : fwR! ~uiW M~wwt~ w~~a: ~ p~~t~ u. w!r t~~ K~OE: ~ 7w Lc. ?Y INJUtY wT vvORII KwCE OF wrilttf ww. r.~,., uru, r.t*on, IOCATKM~ ~ scaen w~.~.e_ ..o.. an oa ~o.n., u~a ~ ~~recurresa.w~ oN~cewe..ex ~srec~..~ 7M. 7W ~ CEliiiK/?Tqa- +a~~N w. .E.~ +.o..s~ o.~ .iu u.o u.sr s.r w~ne~ .a~e o.. WOIDM wOt r~lr nalo[~rN ottunto •t swe n.cr. w w ?NrSK~wn_ TO ro..Tw e.r nu ~oo. wne~ u.n. ~+ew~ o•n. .w. W~.e ns~ ~~nt~ofo iw~ 3 27~ ~~r ~ Y~ '~7t 74 ' M o a~! UrS.la~su°!~ ot~..uo..o_ .Sj 7~ 7- ?4 ~5~ 1/ / :0 ` CERiMKAIiOtt-mEDKAI EtwM+trFt O! CO~O?+E¦ a+ •~e ~.s.s os *¦e ,.ow d a.w~ rwc e~e~oe.n .r.s ~~o..ow.cw ae.o ; f~~rw~tO~+M M! W ~••~.0~ ~w! wvlir~ ~tG.. w r~ ^sr~b.a. ~N Wt ~E~~ wbJt Ol~Iw OCCy~tlO O+, Mf O~R ~NO Out W~M Cau3[cfr SLtlO - ~!a ' M 2!~ M CERT~i~E!-ruMf ~rrn o~ ~r.,.r~ ~ 5~:,?+~iUtE wa~re w n+u ~OwTE SK,NEO ~~o-. o. .~~u~ Ralnh :i. Ureer.;•~asser, 0. - ----'rr'-~' i MwRM1G AD[AtfSS-CERi~fif~ a~a~~ w~.r o..o •n na.~o~v« s~•a tu i~i ~ ~ a.:=a+; o M 7 cr'•:~ WRUI. CtErutrOe~. of~+0i•w~ CfME/E1tY OR CtE!W?iOR~f-w~E ~i~ounoN r.~ w w... s•.n ~ YK~4 ~ ~ . tw . o Qya~ ati ilU21St311 ~eT°tE'~"V ,za acarboro, t~.222:° Ow~E ..a++~. w•. n•~ ~ FUNERAL MOlME-NAME AND ADCfESS 1~~Flt C~ ~ i O MO , Cm O~ tO~+w, :r~~~, t~~ ~ c ~ ` ~ • ~ ~ '^a:~~rac ~ a. r~t ' ```\r'~ ~ ib ~ j Q~ ? (`jLr . O I1~ 1'C Z ~ 1 ~_'Jf. , f • + • - 5. 1R li fL.'YE4~~ _'~~7v.`~! I~GIS AAR/-i'W1~T;ltf ~ ~D~,f RfL[~~ln tOC EG~}:'~ / ~.~RlV.19~~ ~ :M ~1.: ~ ~ ~ ltM~ ',L R~ 1 ' / ! ~ ~ ~ . .t- ~ ~ Y. _ ~ C~Cu7'! CERIIFIED COPY 1O _ - •••..,F4 ~ ~~I ~ I he~~'elit~..gt~,}~y ~~h~ a'tipve to be a true and correct copy of the Local ~ . ~Regi~srr~~'~i s~~a~ p~.~ F~le in the Eroc:ard County ttealth Depart~ent at ~ r~ Forf, ~..aude~~e,. F1q~dg. oni ~ . ~ .1 : " ` : ; ~ s~ . A ~ (WaYnii~~:,"NAE~v~~3.~'~d~~~Sless raised seal of the Broward County Health N?Q~y t ' ~ =~fi3~~s~t;n~~?~~is~ affixed. ) o`~ F'~ ~ l• ~ ~ n~ . . J ' ~ ~ ~ - L/! iAti~ ~ ~f~i y. IJ~lj . Cou y^ eafth Offic~.anc~ ~al'3. bistrar t L ~ ~ t i / ,~tv! . / • ~E'. S _ 6 n / . • Y R Deputy I/6ca1 Y.e~istrar * U ~ ~ - - " : ~ 1' 4~ ~ aq - ~ N ."'---~.sz . . _~~..e~ 1F°'_ . : - `r+:.a~