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HomeMy WebLinkAbout2496 V ~ / 293385 cEe"~c71FlCATE OF DEATH iTATi FiLC t~0. De~rn~e«I ~f 1 kalt6 ..a tt.~..i+t:~.~i-~ F L O R I D A Ill~'N(1Pt (1F Ik;~llil REGIGTRAR•S HO. SQ4 ir ~I ~R~l A~11w0 ' 1 YIE. O! ?tlNl IN - a~ft pAjE QF 0(AM ~~Ow~r, 0~~. uu ~ ~I~MANlNT INK OECEASEO-N~M[ ~u1~ row~ ' uE ~+?ywor ~a ~ N. DII~iIS r Ma1e ~ S~pt~ 27, 1974 ~ssrwaa.s ~ . RwCE .wn. weow. w~Kw w~w~, AGE-a.~~ r..s~~ ~~e.~ u.+oe~ ~ wr OnAyTE Of WTM ~.~w~~. w~. COW~Tt Oi OfAiM ~a. ~sra~.~ ~11~ w"~~.a.u~ ..of. w.s .owa `J2111. u~ Z89Z $t• ~lCl@ ~ ~ ~ w - M~.. an ,~~~s „osMr~~ oa on~u ruirtut ~M ~W w lm~l~, 4M ftM~t ur0 MWt~ ~ 6602 . town. w ~ou?T~a+ a oE~TM „o p~~ l~ yes 1901 Ave. 8 A - sutVnr+G S+OVSE ~+•re. a~n ...w~ .~w ~ SiwiE Of WM ~ r¦o~ w v. Nuu GT~ZEN Of w?u?t COUNTRY ,~W _~~~0 ~ wcn ~ to~.,n. ~ oq.~r~a, • ~ ~ ~ M1rr1 Marie Bassett~e ~ uwu aue.~a - vMY MCI~ftC s«W SECIN~iY N!1/ME! USNAI OCCWATION ~G~r! awn W rGa 00~+~ OWw6 +Of~ M [1ND ~ WSf'~ESS O~ It~l?STlY ~~vl~. Y Ol~M ~1Wt~M0 F~r tl 4~ ~(~.1 ~ ~ /~.~{~S ~wL C~1/'1~1 OCCYWO W '131-10-3076 A M~~ t7~ 'N•~Jj~•~• w"~I ns+wwc~ew~e ~t ib. CITr. TONRl.O~ IOCAttON wsre tn ures STlEEi AND MSW~EI .e.rWO... ~swt?+te-srsrc couHn ~N YPS ~~.~~.1901 Ave. B ' L~? ,y Flarida ,p St. Ixa~cie ,u Ft. Pi,erce . y.y~ MOiMER-MAbfN N4ME ~wl~ ~ fAtNER-NAIMf ~~ar Charles F. Dezinis MatiLc3a ~t~5 „ ~ I WOM~unT-r~urE I Mwi[WG wOC~RESS ~srne~ w~?.~. w. cm w w~..., s~.n. ir~ i,,, 1901 Ave. B, Ft. Pi,eroe. Flar'i~7a 33450 ....o.,.. ~ ~ IART 1. DEAM WAS CwUSfO ~1f. ~fr/TE! OMl' OME UUSF Ift /wE f0~ (el (SL ~?'p f~ll NI~'!~M OMSIf ~MO OF~iM `Y rrwa t^u~ l~. Ga 1~1 , . . H /r (ON~111ONl. ~M. rr~t~ G~rl ~~s~ w 1!) ' ~r.la•n c~vSt ~e~, ~ w. p•s • cwaiow.rce c' ~ yt~llMO iM~ YMOl4 F.1 ~\IM6 ~~Yk (~ti wUTO?SY IF l'ES r~~~ r~..o~..cs co»- IART Y. OTNEA SK/N~KAHT CO~~Wt1OMS- CO~~Wp6~f CO~+~WYhi+6 q M~M NR MOt ~F4~ry~ 10 C~YSf 410~w ~ wi ~ ns w•a~ a iei: ~re~.u..wo c.va W (iA ~ 1 lrnWtari /~CGOE-- NT-, 1~ ~DE~ Ow E ~.a.n~. o~~, ~t•~ ~ MOW INJUtY OCCUt~FD ~ er~u .unwt p~.•wn ~r r.i~ ~ w rut w, a~.. ~ ; NOruGDE: Ot U?QEtEWwEO ` ~ ~ M ~ Ih. M {101 ` ! sneu, ~.cwn. taC+~nOrr ~ sne:~ w~.~.~. ..o., c.n o~ w..., sun ~ ~ IHIURY AT WO~K ?u~CE Of ~1uRr - f unun nsq••0~ OAK! MOG-.~K. ~f1lCM?~ •t~a ~ ~w uif Yw w:r/w!~ Y~+! O~+ ~ MO~q w~e~ O(~:10CWUtY O.Twt r.Kt. O+ M { ~ ~ ~ F CEtl1iK/~i~OM- ra+~w •e~~ ! ra.w w. .ww.w wr n.~ wo~ u.o, w w uu INfSKUw: ~ 10 T~ ? O~ r~ [r4~+UOGl. OW _ ,.R~.~..~.. eb 1? 1~69 ~,,.~-.,ril 2 74~~~ A~ril 22 7:~~ ~ 11 .o...~,~,~..~ ~ n~ ace.ue .w+ ~ tM~ OlCfOlM ~13 MOMWMCfO OlN ~ CEtTY1UilON-MEOKwI f7IAAYNER Oa COlONER: a+ r•~e ~.s~s o~ ne ~w~ a oe.n. ~TM o.r n.~ ~.o.n ttYM~~~ M Mr qO~ ~M/W ~11! MIST~fJtO~~. ~~f MM~OM, ~ ~ _ ~e•r occuwo a+ w wn ue we ~o n.e c•~~s~ s+•rto. M.~77~ ~DATE.~~?44 ~~j~11 NT~ RYI . ~ n" ~ S T~ E et4u~ o~ nnt CERTIFIEt-HM~E ~~rn o~ iw+r~ D t ,tk '~v/ 1~ t~. ;~.F. "atkinE, . a z,.~ ; 34 0 ~ MAtWG ADfNESS-Cftili t s~r~T_p~ ~.r. .a ~ r , a ?o Fort rierce rlori;i~ _ l~~ u~ oa wrr su~t ~UMAI. CtEM1At10M. ~EMOrAI EMETfRY Ot CRf/MT01t~-N~Mf . ""~"~urial Hillcrest I~,em. Gax+dens Ft. Pireroe Florida tN ~ fnt~7 W~!.O. MO., C~' a tOrw, ft~f1. I~I 1 . D~if ~.~w~r. w~. n~~ iUr+El~t HOMF ~vD w00tES5 Pl~e~ 33450 , pt. 30, 1974 ~~II~RAL IR'~.901 N. ?th St. wn ucavco ~T ~ow ¦tasiw v. s. s6i2 u~ s+c..~"' eEC~~ -s+e""rwE ` _ , x? 4 974 • A~v.19T0 i xrr - a ~,N=~ RE~OR f~ ` ~ ' . 1 h~nbY a~tify ri?b to bo a ~rw and corr~ coPY s~ R~~~~ P01~OUilt ~ ~ Rvpistrers recar d on fi l e i n t h o S t. l u c i e G o u n r~ r H e ~I f R X CP F E0~ L~ 1~ rtwnt s t F o r t P i s~ c e. Flaida. R E C O I i~ YE ; 0~ ~'?fi. . ~ (yyarning: Not va~id uniess ra~s~i seal ~f ths St. l~ci~ 1~ ~ ~ ~ a o3P~'z~ ~ ~ Counry Fle~lth Depa~tment is affized.) J, ~ X..: ; z i ~^y„~~ ~ ~ , . . ~ } _ ~*4,{~-. N. D. MtIIER, M. . j J• ~T~ ~ Rn,~na~ 293385 y~.: : ~ ~,yroy ~Mwlth Off~ur 6 - OJ 'd~ s"~tca:~• l ~ ~j~~t ~ ~fi-._-:il, ~ . ~ ~Q 'il 6 " ~ • - ;,;,c~ . ~ ~ pvputy Local R~~strer ~lt:.:'..~, ~ i f a 4 { _ $flQK ~3~ ~ z49~ . . . ~ ~ . - - - - ~x ~ ~ ~``~-"~-c a~r',~k„~-'c ~,~,~-n: ~i ~'~'°~.`ti~~ i5f 5 ~ ~ r ~ _ ~_~...a ~ ~ s