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HomeMy WebLinkAbout1155 , , , ^ .1 ~ ~ _ _ . _ _ _ : . rf, - ~ . • ,C~ . ~ _,D~DE COUNTX.,_ ~ ~;641 ~ ~ . _ - - • ~ ~ ~ ~ • ~ DEPARTMENT OF PUBLIC HEALTB MII.~ON 5. SASLAW. MO. MPM. I ji~ ~ ~ 1860 N. W. FOURTEENTH STREET DIRECTOR ~ _ ~ - ~ _ MIA11iI~ FLORIDA 33125 ~ ~ ' _ ~ 1 • ' ' ' FILEO AHD REGURDEO ~ ~ SL WCiE COUNTY FIA. - • ROCEa POITRAS ~ ~ _ ~ C:'?`' ^~~nT r,~URT ~ .~.rl .j ' ~ J . NoW ~ 2 Zo PN 1~4641 CERTIFICATE OF DEATH 1)r~iar~mewl 01 Ilea~l~ aad Rc{wld~llalive 1n.ires dTATE FIL6 ii0. ~ ~~~~~v ~u_.~,~~ F L O R I D A ~ ~~dm~+R•^~° ~ ~ REGISTRAR'S NO. yK CECE~SfO-NM?F ~~n~ rroae ~•st ~7( DATE Of OEAiH ~ roM~~, o.•, ~e•~ ~ . ISA}3~L r`::Iv'L~~7L : r'emale , August 7, 1972 - Rr~E wM~1~. M~(jp~ ~Y{~K~N ~wouw, ~GE-i~s~ ~+~+u~ v~oe~ ~ w• DAiE OF ~lRM ~ro~+TM. o~r, ~QUNiV OF DfATH . e•: ertor.~ o~~ ~t~•~s, ~ T'-~ ~ea~~ p~ i.:ll+.~ ~~2 xres. I w.s r~owi i el~l• 23 ~-:17~ n Dade ~ Ci?r i4MM. Oi IOCATION Of OEATM ~~swt t~*r .W~n HOSIfIAI OR OMER NSTRUiION-r1AME uof w t~rw~ G.+t s~ntt~uo Nu~u~~ ~ - . SRO~~ ~ff O~ ~ ' ,e ~1 ~Portal Yes 8b20 N.S, lst Avenue _ ~ 5?~?F Jf 6:Rin ~ n wo~ ~ s.. ~+.t CIT~[fN OF w?uT COUNTtY M~PRtED, NEVER ~.URRIED, iSllRVrvf1G SPOUSE f M M1~(. G~Y~ yAp~N M~/~11 ~ evw~n e w U. D. f0 ~ vse+• ~ ~ Ohio . . U.s.~. IN~°ic~o~ __iiona_ SO: SECURITY NU/~6Et USUwI OCCUPATlON ~e.~rt awo o/ y+e~~ oc.+e ew~.w ~oar or KI~ Of lUS1~SS OR INDiISTR~ vron.a~ t~r[. ~v[n n een~~o 1 - Hon~maker Otm :'_ome ~ : 262- ;~-50~9 }~y ~ - - - ~:S~DEhCE-S1ATE CWMY CITY. TOMM, OR IUC~TION u~sw! cm ~uuq STlEET AND NUM~E~ ~ /3rFt•~~ 1!f W MO ~ ~Zorida ~o Dade ~~1. Yortal Yes $620 21.,. lst ~•renue f~ MER-- hAMF n~St r~pOat uA MOTHER-A4AIOE^~ N{Mf ~~~St r~pp.! ust , ~ Unobtainable r~~~~ ~ r:f~pRr+Ar~T--NAME ~ MwIING ACLRESS ~s~e~e* o~ ~ r o ~+o . cm w ie.K, sr.~r. tu~ ~ Jo s ~ h~ ne T~en].ey ~iE:20 I~ lst Are ._~1 rort,a7_, Florida ~ ~ °q"' ~ + pEAM WAS CAUSED bY: . ~fNTFR ONIY O!JE CwUSf ifR lWE /CK (~j (b;. ~t+D ;<)i ' •nwiuuif ~.+t tv~ ~ltrfL!a ONytl ~wp DE~TX ' . - 1rWD,~~t C~USf _ t " " I Arteriosclerotic heart disease ~ ~i u . oa .s • e..uoue~+et o. - . i , ~~6~r,.,~s. . i • 4•r! ~~3[ f0 ~ lb1 _ _ ..ec~,~e :.~se ~o:, ~ ~e io, w .s • co~s~~oi~~e o: - ~ s,.•.~~ i~e u..oFe - f + . . ~ :.uiE ~~SS i t ~~S?? OTHER SlGNIFICANT CONDITIONS- ea+w•~~r.s c~..~n~unrw ro a.•~ wT ~o* ni•~FO ~o c+vse a•ve.. •.sr ~,o~ --~^TAUTO~S~ IF 1IES weec ~~~o~~GS Co~- ' _ ~1 ~fS O~ ~~J~ S~OI~fD I~a Wif~r~M}NG G~Yif O~ Gl~eM ~th~~ - IK ~ eMb!~I ~Ct;GfNI. SUIGOE OR ~ ATE ~f WJURY ~ ro..*«, w~, re.~ ~~MOUR . NOW INIUQY OCCURRED < i~r~~ ..~ren ~s ~wwv ra~t ~ o~ r.n uw i, i.^•r-:_ipF. C~ Ut~9EiFRAIlINED ~ 15:.~r~fl ~ . . • ~o ~ .}ry 7k M ' MI ~ N1URY ~T WGRK ?IACE OF W:U~Y •T iw~+~. rur. sran. ruson. lp~A~ipN ~ St~~fT O~ ~.1 D. MG.. Un O~ IO~+w, surt ~ . - S~EC~~• ~eL O~ H'J~ OrIKE hOG.,FK ~S?K~~~ ~ ~ . M1 IG ~ • CE4?IfIG:ION- ~~n D~r ~e~~ ~+Oe.tti na~ ~ .t~• wqO VS' S~w ww/Mt~ ~1•.! W+ ~ 00/LW 1+0~ r~lw iM DEAiN OCCNntO ~t iwt ?uKt. O~. n.E ~ ~Y+`S C'~r~: TO rO~+M C~~ •E~1 .~00~ ~17t~ O!~*M ~rq:~• D~rf. ~~+D. f0 +h! NS~ ' •rttr~0~0 TMF O~ i++O+~s[OGl. OW i!~ CEit~3lD ItCr ~ ~I1~ ~~II ~tl~ ~TI• M. /O SM[ C~YSl~SI ST~TlD CEk?t~iUTlp~-ME01CAl EXMNNIfR OR CORONER o.. :w•_ ~•s+s o~ r~e «o~r c. r:.r~ :~~~e o[ciceKT w.9~~S~ ~¦1 i t.... r.•,w O~ trt lOOr ~.M/6e rNt ~nresr~G•~~O«. ~r. rr O~~v~~... . ~ •~us~ j 7~~ "0.~~:~~ 1 =F i'~CCO~~fO d~ Mf DA~f ~NO OVf 10 fw~ (~VSl41 S~~~/D h 1 A ~ M.(rn M :Eat,F~fR-tUMF mrt w rnar,---- TSK.?d~tU~ ~ ~ ~ ~j~G~fE Gf rn~E ~6~lE S:GtrEU ;•o..rw, c... •ew • , - - Brian D. Blackbourne, M.D. j„~ •~~.Ic~r._~i..M.D. 8/7/72 ~ - V 4t; - ~ iHl~ O~ ~./.D MO ~^W T~ St~~! j~~ _ ~N;~R` _ _~A`~•?~~, ~tt i~~'S Of ~iCE'1 c~e it . ~3. lOtn ~~vc . :~ia~::i r lorida ~ ' g_~4ut. CREMATIpN. RFMOVAL CfMEiERY OQ CREMAiORT-N~.vf IOCAT~ON on c~ ~o«.. sn~t t~fi~~f i ~ Cremation Lithgo:~ ~~re~!ator r~ _ _ 2•Liar.~i~ orida _ . ~ ^~1E ~ ~rd~rM, owt. ~tui FUNERAL HOME-~N.tA4f AND ADOR[SS ~ s~~eF~ o~ ~ ~.o wo., an o~ ro+~r, si•~t. t~~ ~ hu~rust 10~ 1972 ~thQa~• t~ eral Qnters Z~ ~ ~ ori~ ~ ~~'NF- - - CTOR- REGISI 1 AR tECErv[ ~~~Qy~l ~G~SIa~~~A , - ~'+'~~f; tl~. 7N UI~ L - ~ ~ ~~~:ti.~~~."` - ' ~ lipifii `~.~''...^.'i5..,.. ~ . ~if : ti~~~c ~ ~j gg'+~g~~Fgplyg. TO BE A TRUE COPY C~' THE IACAL REGISTRAR S RECORD OF ~ I HP~, . 3 ~ . ~ DB~'Pf~, : - p c - ' ; _a . ; ; - ~ . ' ~ ~tiD~. . . R,1~;1~` , ~ ~ S c~ ; ~~~tat~ s u~' . ; r ~ . . ~ ess the raised PUTY REGIST t 't~a~i~`~~ ~ VITAL RECORDS UNIT ' ~ A, a~;. '~L4 ^ o~~~ Bureau of Vital DADE COU[3TY HEALTH DEPARTN~iT ~ - ' ~ t~i~1~e~ is af~ixed.) . . o R~ ii5~'~I' F~~~ ; ' ' ~°1'' r ~ ~~r~ 600!( ~.e~J PAGE . , . . _ - - x . ~ ~ ,