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HomeMy WebLinkAbout0285 CERTlFICATE OF DEATH Deprtwew~ d tk~l~6 ~wd Reb~bilitall.e Crc.ices fTATt Fltt NO. u,~~,~„ ~.,~,H F L O A I D A *r?f. Ol ~t~NT IN NEGIiT11AN'! NO ifl1~AMN? INII pKEASED-?~~f ~•~lt ~'oMf ~~sr SEII 04iE O~ OE~[M • row~r. o~~. •U~ ~ S4f IMp~001 f0t .s~oc?a6 , Cl~ra Coti•: ell r~ '„n i•' RACE ~+n. wfOq. ~w~K~M ~..ouw. AGE-uf? w~w~ ~•e.~ w~oe~ • w. OAtE OF {~RtH ~.w.n~. o~r. ;C01N~TY O~ OE~M ~ N~nN~~ ~~U~S~ ~Of. W~3 ~OY~1 ~w 1 r1~~~ OC. ~ fMCV~ ~ ! . ':Ihite w ~ J?n. 1~ 00 Bro~rw , Cllr. fOWH. OR IOCwT Of DEAM ws~a tm ~r~n MOSMiAI OR O'NER NSi~TIli~O?+-N~ME ~••e se~~' •'4 ""k~' I b ~Q o. Holl ?~7ood Yes ~20 S.'.~ . t'~. ~ve. _ STA1E Of W1M ~ u Not ~w u s~. w~r~ d112EN Of W?1AT COlR1Tl1I MARRIED. NEvER M~RR~ED. SURVrvNG S~OUSE ~ v+~'~~. r.^~ w'a" cow+n e WIDOwEO. D7v'ORCED ~ snc~++ ~ . ~ ~ . II.;;, Divorced none ~w.,N~~. ~ teYl21@3.:~ee - - ~~.en acuue ~~~u s[tunri r+u~e uSwt OCCUt~~~ON ~e.a ar.o o~ ron oo..e ow~.w +•ov or ~wC Oi MlSIr~fSS O~ ~t+DUSrir ! .rvee ~r oa.M wpar+6 urt. M.. u ~~r~~t0 ~ . O(cu~lle w . O~~m ~O~e ~^~^a•~^'~ „ UnoStainable House~ife :ea+oe..ce rw~e rs~et tm ir~» St~EEt wr~D ?~UM~ER ~n.~ssa«. RESIpEHCE-S1~iE .COUNT1t dTr. TOWN. OR IOCAiWN ~ ~ s~~e.n .ei o~ ~.b ~ ~a Floz`ida ;3Y'O::ti'~-..rd T?Ol.l Y00C~. ~u Yes ~217 j.~:. Z'1.~1T@. fwTNEl-?+.u~E ~~e~ +~oou w~ MOiaER-.u~OEN nuNE r~p~ .~oai w~ „ Unobtainable Uno~~ainable ~ I WORMANT-N~wE MI?llKr ~OORESS ~u~a~ w~. a.w . cm w•c~~ s~ `n. t+~ , T.~`. -~^_I~c}.2'~1uC • ~ ,.~'?7 - .~V@~~ .i01_~''~f~C~~ -1•?j'l:~•: Ih ~ ~ ~ ~1 t ~~~+1 l 171 •rr r.. ~w1i 1. pEAM WAS GUSEO ~T: IENiER O?dY Ot~E UUSf rER IM~E fOf (ot, is). ~ND ;nl terveM o¦sn ~..a x.-r a rroua cws~ h) .G'S~~i"r!'~l.L~/~i~ I/ L~ •/'!s^i~ ' • . ..se • - . / 1 ~ ~ co¦Mr~oMS, u ~r _ rs L.± : ' ' -h~-~..-.t/ ~ ~ yi.~ i~-~y__ ~t!.r... ~ ~z/!~ ~ •••~Y'~ ~wKM 6~~f ~~S! ~O . Irr~p~T~ UYS~ ~a1. pk t0. O~ ~f ~ COMStOVlMCf W+ / ' 5~~1~M6 tll~ YMP~~- / ' 1 lTIMO C~Yf~ lAft _ ~ ~t~ ' . - - 7 ?wRT O1MEt SK',tr~iK~wi CO~+WT~Or+S: cwanOMf COMMNn+f. q Ol~1w N/t w01 ~tutt0 t0 UYf! GntM r.n ~ a~ ~~r ~ ~ES ~.ee~ nwe~~es e~.- i ~tlf Q~ W Oe~iw~ Mr~tr~w~wG C~uf! - I~O ~w ~I ~~~.~1~ 1 J?ObDEMT. 1 O! A ~roMrM. o~t, R~t~ NOW iN1UR1/ OCCURRED t ewn~ wrwe Or ~rwt. ~N ?.n • p~ ~ut u, Ptr i~~ ~ : pR {?DEiEtMU+ED I ~ M SM 1lWRtl AT wORK MCE OF ~NM~ •r r.u. fnt[r. ~.cron. lpU~ ~ snen o~ ~...e. ..o , un w w..., sr.a r f ~ ~ ~ Mean ns o~ .a ~ ow~a woe , ~~t ~ srean ~ ~ m. CERf~f~C/?TqN- ..o.rtw o.• .e.~ ra.m o.r .e.~ .,.o us. s.. r~.i~e~ .?..e a. ~~r~oa .o~ +m~ aw Ol~M OCCUttEO u s+~e ?ua. a. rH ?Nrs~u~M: / ra.n. w. +w wo, .ne~ se.w.. ,,,ou~~ ~'j o•n, ...o. ro *.e ~sr 1~fllwpEC tw1 T~I' 7 28 ~T G rr [~+O~~tOGt. OY! ~ OlCf~S~O ~~Or 6 ~ tl. ~ tt~ th . j M. ?o +we c.uu:s+ vas. CERTMK~?ilpd-MEGICAt EkAMWEI Ot CORONER o~ rwt us~s p ne Mov~ a a.~. ~~Me ac~a.a ...s .w..ou..cw oi•o [,.,....nw a ne ~ow ..~oio~ .«i w+es~w.r~e.~. a..a». .o.aw wr +e.~ .ow Ol~m OCCWMO O~ M! O~ft u~0 OYI q iwt 4uft~i~ Si~rtO. M K 7f~1 CERTIf1ER-?~AME ~me o~ n~..r~ SK,t~I~iURE ~ aea~ ~~ne ATE SIGtJE~, +o~ n., wr_ .tu L. Cahen, rt.D. rw i ~ ~ (rk j ~ ~ MAIING wDWESS-CE1iKKR uwE. o~ ~.r o..o. c~n u.o~+~ , sr tt i r »i ~ 7 J' t t., o a 3 d t n {11~ut. ClFru?ti0?~. RFMOv~t ' CfMEtEltir oR CREiw?iOlr-w~u+E ~OCwnOt~ c.•• u w... s~•~e ~ srecrr . i:rema.tion ~~to ~1 P41r~ Cre:nato Po~ ano Beach r 1~rida OwtE ~.w*r, o.r, ,eu~ iUNERA? HOME-r1AME INO ~OOfESS ~ i~nu o~ a+o , a*. o~ rov+.. sr.u, i~r ~ :w~ Jui 30 1974 adlin~-ton-~rer_~*er 201 . Lc'n. :-a. ~~.1? ^~~3~ le . ~~la. Y. /Q 1Q fUnE~?L OMECfOR-SiGN~~U~f REG151RAR-LGNA~{iRE . D~IE ~fCEnttr/~ tOC~t ~fG~STl~~ i~ ~ R~v_ 19T4 ~y~ v ~ r, . ~~.C f ~.'a~~ tM n cL'rLt_ t ~ ~ ~t..-t..L- ~ _ tf? ~t~t. ~jC 7 ~ r r- ` _ , ` ~ - ~ CERTIFIED CO:'Y ~ s. : : ,a ~ ~1 I hereb}i ;serti~~~'~b~v to be a true and correct copy of the Local Registr~ ;s ~g4r9$l~a~~t~~~ in the Brokard County Health Departnent at~~`' ~ ~ Fort La~i~erdale:~lor`~.~ • ~Z? en a,;rq . - • •t ''.,~i.~~f O 7u~~jG %;i ' ~ " " ~ : • T) `~n!7 ~ (i~larning.°~•.~bt~ •~f ~ eys raised seal of the Broward County Health , u~r ~~a t~ ~ ~ ~~,De~~ `~Y~ affixed.) ~ • i:~~ ~ ~•s:~.~•?' . ~ ~ ~ ~~~iTAL c* ?~a ~ - ~ ' ~ G k•~~) ~Q~ Count 1lealth Of£icer~f~d I.ocal Kegistrar 3 ~ BOQK ~.V~? PAbF O ~ ~ ~ -~~`~~303 ~o~-~~ : ~ ~ ~ ~ Deputy Lo egistrar ~ - < s - rV~~~~ ~ ~ ~ y x ~ F ~ ~z ~ . ~ _ ~..k .a„~ sa~ ~~~~a5,~°~~~,.~~~~' w. ~ a~_~'~~H _ , ,