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HomeMy WebLinkAbout0224 p: . ~ ~ r. ~ - } _ ! ; ~ l ~I ~ . 293931 CERTIFICATE OF DEATH ~wTC r~LC Mo. - ' n.,r.,.,.~ .t i~.~ e`i"F"w`.".''""k" F L O R I D A p1YtiMW OF HF.~I.1H . 11EGItT11Al1~f NO. ~37 - ?~1Nt tN w~~+~werw.w.e OA1E O~ OtwM ••o•~•. q•~ ~ j ~sc~iuri~ o ia °~"~O_•?,re . ~ COLLII~IS ~MAi~ = OgTOBER 15, 1974 ± rsatinaai , ROY ~A w~dp ~wM~w, f AGE-~~11 Yrw~ ~•e.~ ~•rt~ DwTE OF NIfN ~.a~w. N~. ~C01N+1r OF OfAM .o. «.s . i 27 ~ 1927 SAINT LUCIE .u. ~ wc., ~ ~GRO 47 w is. _ - - - . ~ ~ r Ma :w e+a+~, cw~ sn~i. w.rr~~ 66~2 . TOwM. O~ l w IW~OEATN ~ rLM c.~ ~rr~ NOSMAi O~ O:1~ER NS ••yEg FpRT PIERCE ?!£MORIAL. H0.SPITAL _ F'ORT PIERCE ~.+a srousE oN. ~ - SrATt o~ wn~ «o~ w+.•.. unzEN oi w~ur Co1M+t~r wunto. Nfvtt wlRlsec. • ,~„oow~r~ ~ ~ ~yA HILZ.ERY ~ ~ ~GEORGIA USA= ~N , ~twu nfMwG i_______~_ OCCU?AT10N rO~N aw~ a rO~~M.~O •os+ a RND O~ MlSNEiS O~ M~~~ ; .wr y~w ~nr NtwvE~ ~ . < ~ Kw w~a.o .w. e•"' ~LABQR~ w,~w o» a•. „ 727-09-0450 if " ~ E uweMU wror r~aw tn ~~f ST~EEf N+O MMyE~ ~ .wwo... ~eswEncE-sur~ cou.+r~r tar. rowN. oe ~ouno.+ ~~c..•~• S•~o ~M 1215 Avenue nE'~ ; FLARIDA t» SAINT LUCI FORT PIERCE ~w ; wor~e-iw~otM wwE yp' ? /ATNeI-wwc M~aGIE ~T , Ai~p COLLIN.S" ~ ` ~s ~u?Rr+c ~oc,~EU ~ara w..•~. no . ce. o..o... s~... n• ~ urow~++t-""+~ ` ~i ~ Pierce, Fla. °33450 . 1216 Avenue E' Ft • MRS. GENEVA COLLINS = " l~+tE~ o?~ar or+E cwusf rEt t+r[ ~or NL M16 ~ k11 w~ruw own i~ wTM rnn oe~n~ w.s twsto sw ~ ~/'p ~ /~'R£s T CRRa/Ac /~3 R~'~ST ~ hl , . . - , ~OMMI~OM~. M ~Mf. wwKw G~q nH q ~NN~h C~11f1 ML ~ q. O~ ~3 ~ CO~MOYfwG M: . _ yt~tlM~ f~l YM~~~• T /S~ S~ ~..w AR TE ~io s~~~~1ori c- R AyTp/SY If 1fS rw nM«rOS cor cp.raa.s co+w~wo w w.~. wr +or rua~ w u~a~ aw« w nn ~ w ~ ns o~ ••o~ w N~rw Knwrwo c~ /n~i OMe SrG+~riGu+T tONo~?~pas: tu 'i - . ~ ~ ~ww~ rwia w ww~r u. ~u~ ~ w~•a w+ ~ ` !UU t~~ r0~*~. Mr, n.~ ~ IIOIJ! MOW lN1Ut1f OCCUttEO ; a ,.~t ~ /o ~.~E.r~ o Q~i7/lRDO.~/ ~tK f'fo o~R , fi TURAL ~ I4 f -s - ~ ~ /b M. ~ - ~ KwCE Of MJUt~•~ ^ora. s.ro. ••aw•. tOGnOt~ ~ swao e~ as.~. w.. car w wrw. s~~* ? i ~t ~ ~a ~9v,E F-r o~E,z~E. ~--c.~ ~MK1A ~tf O~ MOI OAKf ~~f..~K. ~fMCV?~ 7A ~ ~ Q * 3 r. - w~u .a.w +w ~.r usr s.~r wr/.iu ~uw or ~~w/M w~ .M~ we o[sna~oGCV~lEO w~ o M~ia~ ~pea~ . ~4~7M M~ a AY ~OM Y~Y ~tw. tw0o~~ !D a u+OMlKrl, M ~ ~ CEttrfCA110N- ~M~1K~: . TO ~ JM k f0 M CwM01 l~M. ~ ~tww~eo ra ~ 74 . . fb ~ec4.u~ rw+ w ~ •a .w~o~ ~ CH1/IGT10M-MEDICAt FJtAMNER O! COtONEt: a. w us~s w*a .oM a a•~. ~ . ~ tarw~wow O~ ~f W~~ ue/M r~ wweSnG~tor. ~a .n WwW~~. ~ , - - M . N~w OOCY~M~ O~ M MA b vt~W 1V K j„_ t N6M~ p~1N SKsl~~ 1'b'~~. Mt, RY I ~ cee-wuwc a. - _ - • ~ ! 0 Sr- f u ~ Z ~ an ~o.w s~.w d' , ,+wac _ ~ ~E ~ u..n .b. _ _ ~ l~ ~ eu. oe .w.. Ent O~ CtfruTOt'f-N~wE weut. uuw?twa. ~+ovn? FORT PIERCE, FiARIDA PINE GROVE CEMETERY r~.. BURIAL ru D~tE ~.a~+. rr. .w ~ fU?+ER~t MG+E-?unE MD w00RfSS . sn~n w u.~. ro.. ews o~ a.M, a~re. rr ~ 7!! OCT 9 9 ~ _~~rtKt ~ ~ w ~ ~ ~a~rco ~ow acwrw +r. s..s~z a-~"" x? . October 22 1974 Rw. 1970 ft0E0 : ~ : t~?~nbY ~ify Mb to i~ s ttw snd wrr~ct ooPY aF tM Lou+l p{`EO AN~ AE~1Y f1.A~ - fbpistrors reoord on file in tM St. tucie Cou~ty Health ~~aA- ST LUC1E ~~p1`RAS L\ • irwnt ~t fort Pi~rte, Flaida. R~~E~ tS COURt :~~1~11 l~ Yd~o~;~ _ CIER~ q ~ .1... (yyarning; Not valid unfeu ra+se~i seal of ths St. luci~ RECORC ~EF~~IE ~'K=-~' y o,~d, y~ Counry Heahh Oepanment is affizod.? t9~ ,~t. - ry` ~ 1 -ri f LT 'fi W . . 23 1 ' ~ ` Oci ° ~~R ~ ~r : N. MIIIER, M. O. - ~ : ~ ~ ~-r < ~ 'Hoslih Offiu~ b l+oa~ R~Qistrar ~ : a'~ "z, k: ~ ~ ~93 ~ ~ ~ ~ 931~ ~~~1~:iN~~.,~, /b ~ • . p~pu~y Lou1 R~aistr~r - ~ goo~z~3 ~ zz~ ~ . . - ~ . ~ . ~ _ _ _ _ ~ ~ : - ~=x ~ ; - -s = 2 ~.,.H... ~ ~.-,v~~~~. `~T+~~~~h:~~~~~' .L...~ _