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HomeMy WebLinkAbout0322 ~ ~ 04U~ ~ ~ PAGE ,~?,~[..`.lT/'~, li..r i1.,1 1..) f~~.:~Vy Y~ `~.J b+ 1.. . • ~ ~ '~{I•~ . ` 1 • Y ~ . . / ' • ` ~ ~ . ' . H ~ALTH L~EPAI~TMEN~' ~ ' • 40 . . , , • F~~ ~ L~ • ~ ~ 1 : ~ • • ~ ~ ~ 4. . ~ ~ , ' ' • r" ~9j 4 tt~ EAST GRACE STREET r'~, . ` . ~ . ; ,~~i , ENGlEW000 ANNEIi ~T. ~ ~t?NTA GOROA, FLORICA 33950 • ~ ~ ?HOtil~e: 1~4-~to 3 ~f ?NONEt ~3o-11it 1` CA~,~O ELEO AMO RECORQ~4• i~ ~ ' . ' ' T . . S~.lUC1E COUNTY F A fl1ANC1! R.Q~ M«E~YE11i. M. Q ~A ~a~ ~F CUUNIY.R~R . RE C0~ RK ERt IED COURT . I.UR~OH C ~ CERTIFICATE OF DEATH ~ 38 pM'~~I p~~, D~:d.~e.~ .t Ik.ld~ ..d Re6.b~N~.the Se..kw RI~ Na. ~~~~~~~.n~ - FLOaIDA Tr?E. OR ~arA I~i~ 11lOItT11AR•f NO. • + MlMAMlNT INR ~wt ~ OA OEAiM ~ rowte. wr, au ~ SfE MIM~I IN • •m~~ Ha~ael 11. $ieman ~ Fsmal ~D ce 2 U?Ct .~.w. .WOw. .wac.n www. AGE-we ~wrn ~ we. ~«t W?TE OF MRM ~~aw~. ~a. COIM~t Of OEATN pc. ~ wc+.~ ~ M~wM•. ~~wf~ .w. ~.n ~f .w. ~ . White ~ k ~ e~ ~1I, ~Own. Ot lOG? wnw ce,r ur~n !q5?rt~l OR Ol~ - ~ r w emr., ow~ s~en .N nwre~ ~ ~ sncr,r ns w Mo , Punta Gorda Yee ~ H Ided3ca SIATE Of NR1M ~ ir wOt w wr~ p MMAT Cq1R11~Y MI1R~lEO. lE~E! MA~EC. ~r wt. Nw ru~ w~w ~ Illf~oie U.S.A. ~"D~`arr~i `w"~~ Henr $ie - ..~a wce.se. SOtuu SEGU~m MMMEt uwM OCM~t10~+ ~aM a..~ a.aa ww rw~w ra. a IWD oi M1SNEtS OR wDilSm uHOP M.~l~M wp~[W 41fv. N!M M ~tMM 1 IMf1111RM~~~ QIN occrneew It.~2~~10~VY1~ ~ Ib. 71 V ew 1~. ~~YMMC! Q~OY •e•~~-~ ~ESIDErKE-SG1E COIMIY Q1~. TOM1M. OR lOCA1fON ~e+~ t~r w~n S ANO - ~ vecw. nf w w Florida ~w Cha]~lotts G ~a. /Ai11Et-NAME ~W~ r~M~ Wt MO11~R-MADEN NA~K ~ n~ft wiMl ~ ust „ Qeor s hottfn ha w. e R+ro~uMW+,-NA~E ~ W?a~+c ~oo.ESS ~p.n, o....,. wo.. c.. o..o.n..r.~. n.~ Henry $ieman 3614 Yasoo St. Punta Gorda, Florida ~t otnn~ w~s Cws[o rr~ ~Ee Ow~ or~E ausE ~ u+E rat NL AI~ ~ k11 ~ o.w+.rs.wr ~ . N! , Y f' c-I.~ Gl-~,.~ `"t cors„~ows, n un, r~iCw 6~v! n1f i0 ' . ~~atM~1! C~Yf! 1M. MM q. O~ ~f ~ tOwlIOMKt Or• {tAtIMO 1Mf VM~!! ~~1Ni C~YN l~p . . ?ART OTMEt i1C,?MiK~NT CONORIONS: ~,ow*oMi carwMwo a wM w~ ra ru~n a cw~e oww. r. wi ~ rr AYTOK~ IF ~ES rnn nwN~~ ear ~ 1 ItRf p MOI O~~iutw . xo MOW INJINII OCCWREO ~~q u ~~i_OM~DE, OR YNG1tElMwEY _ . ~ ror~, w?, ~tu ~ ~ l~M~ wtw a w~rn u~ ?~n ~ w r.s r, ~wr ~U F ~MUM ~ - 7~ ~ M. iY 11UWY AT M~ORR Of NJt~Y ~w.~. ~.r. snett. ~~dOrr. tOCA110N ~ s+q~t O~ ~r.~_ wo., Gn M qrM. pa1~ ~ ~ Htan ns o~ .a ~ ONK! M~6 ,~K. ~ YKY~ ~ _ ~ 7M 111. ~ ~ - r CERT~fKwilON- +a+M s~• nu ra~~e rw rw u~s~ a. «w/w unt oN ~ M/o~ wa .r~r w~e Otwn~ OCtW~ee .r se ~uce. a. Me ~ /N\SKIwN: TO ' IrOnM Yt Tl/V ~ON ~IM M~M. /MOY~1 dN~l. ~M. ~O M ~tp ~.ne..eeo nn T a.• ~wru~a. N~ n. ««.He ..o.. ~ a 1 '13 ~n I -1 ~'i r~. ~ ~u p n.. ~ M: ~o ~ ~~:t.n.. CERT1iK~?iION-~EDKwI Ex~rr~E~ Of O~O~+E o.. n~ ufn a wr wow a w.w ~we Mcea.h wu norowa~ ~eu u.~,....na. o~ sw ws..w/w an rnn~nw*~o«. o~«.o.., ra.~w n.~ wow ~e•w~ occww a. ~e o.w ..a we a wr uuw~s~ s+.w• M tN ~ ~ C~f~l -r~+f ~me o~ n - S : ' o~~eu ~.a.+M. w.,rw~ . ~ i , ~ ~ / i~ j ~ 1. L'!~. 7 tJ~. / / ~ ~ w?twG SS-CTRn?Er o~ c w~..~ +~c f u~w ir !I1 L 7 WbAI. CREMATION. ~EMOv UMETERt O! C~EMAiORII-?J~ME tOG an w ~or+M su~n ~ ~s?ecrn. . _ Burial ~«Cha~]~o~te ~m Gar~ Punta Gorda Florida 0 DATE .o.nr. w~, nu ~ i ftnt HO~?E - ~rrp ~ ft~t~~• Cm M tOr?M. ft~R tN ~ 22 „~on~er ~""`unera"°~~iome. ~Iarion Ave Punta Gorda, 8~.~- F v. S. ~612 F ~ eEG~ tWt-s~~t • nw n eEaniw ~ Rev.2970 tf~ ~ .•~!'~/4,.,~t tN . . , ~ i ' .J nereby certify ti~e above to be.a true and correct copy of the Local Registrarts record on file in the C~arlotte County Health Depa~tment at Punta Go~da?~ Florida. ~ (Y/arninp:. Nof valid untess raised seal of the Charlotte County Health Department is af ' ~ . _ . , . '~4,• • ; ~ ~t . ~ County N~}a1 th Of f i cer d Local Regl strar . , a -o . , ~ ~ ` ,1~ • . ~ ~bt :H~~;!FC~~~~~~, y cel ~ strar .n~'t~- . i so~2~3 ~ 32~ ~ ~ . s r• lp.c: c a ; - - , -z~_ . N,, __~~~~.~F~~rt~~'~~~~~ t _ _ _ .v~. .s ~ a