HomeMy WebLinkAbout1608 i
. . _ . ...d . _ ~
. ,Z9~992~ ~ ~
- CERTIFICATE OF bEATH
. p~.„~ .t .~~~TMkaa.~ 5~..+n. F L O 8 Z D A s~rwT~ n~t No.
tr1E. OR MlNT IN ~~~~`~d~ R[dItTRAR•f NO.
HtMA~NT IIN( ?Ntt r~M~ OAIE Of OEA1N ~ rOMtw, ~a~, nu ~
AE Mr100f /it
~s~wctN~t ~ W 11 ~ ~ ~1e ~ 1
RACE .rw. wow..ra.uw .~w.N. AOE-w~ w~a ~ nu ~ * OI?TE a M~111 ~ra~. COUNtY a OEATM
nc ~ wcr. ~ ra~r.• ~.wsi rw.. ~.n NoYas "'K ~QC~'i 9 ~ 8~ QO~.ilB~A
~ ~ ~ k. • ta
7?`O G ClI~1. TOWN. l OEI?iN Mwt c~nr ww lIOS/RAl OR - ~r .io~ w enMt~, cM snu* uo wra ~
T s.ar, .es o~ ~+o
, , n. $O H311 h H. B~aoh Ge~evcat tal
S1A1E Of MRM ~ M wo~ w ~.s.•., w.~ Of wMAi COIIKIt1? MA~O. lEV~ MI1~E0. SIIRYNNG S~OU6E ~ r..w. ene r?oe..~.w ~
~.j~ oow~+~ ft e WDO~wlp. ON~O~CED ~ ~rKr+?~
uwu ~tsreMC~ l K~iR7 • V~~7~• Il 11.
v~~+ta oecf~fN SOCIAL SECUM711 Ml1A~ER USUAI OCQRATION IOM ay Or ~O~a ~O~! wwN rOa M R!A Of NlS~SS OR ROIlS1lt
uwo. r w~w ~rp yR ~ r ee~ ~ ~
xcwre w ,t 290-189 311~ q~. 1! ~
~..s*,nrtaw, o~w -
.e~w.~te wo~t
.w.,ssaM. ~ESIDENCE--SU1E COUMt11 CR1I. iO~MJ, OR 1OG110N ~rwM ta iw~s STRHT
~ wan ~ts o~ ro
Florida Volusia Or~ond B~a+ah w. a w-
rAn~Ee_wu~t na. .r«. wr ~wnlt-wAlocw tv~w[ .+v .~eae uw
u. 1'h~0~t8 C
-NAME ~ w?~~1li ADO~ESS iw~n w ~r.~. ~.o., cw. w w+r.~. s..a, r~ _
1~re. ~tra ood 00 3 No~a Road OZ~oa~c?d ch Fla 2
wtr OEwTM wwt WaEO ar~ ~enet O~ar oK c~usE ~ u~ loo~ hl Al ~ kJl n+.wr orR .r .a.~.
M. ~
~ Acu~~e right heart fa? lur_P Immed.
„w,~ a~ Toxemia (uremia) Hours
~..~a.n u~s~ w. M~O. w iu • oowaiw.a a: .
st~nr~ tN ~r~-
W Bronchial pneumonia Days
~AtT OTIN SION~iGWT C~OIOR101~S: oowwo~s oo~nrMn~ q ww we wa Muw~ q c.w aww r. ~rn ~~a /W1GKY ~ tEf wen nMNw~~ ca.-
P V ~ e r0~ ~
w Mterr~s t~wf
Ne hrosclerosis, calcified abdominal aneurssm, no -
~.o.~M, ra, ~w ~ MOvil MWlr OCCN~ ~ u~e~ Mwwwe a wwrn x~ ~.n ~ a r.r M, ~r u~ ,
~ !
1N M. ~IL
V
~ IDU1l1? At wp[ Of INlUftt n wore. r.a., s.~+. ..nwr. WCA ~ wM w~r~_ no;, an w w.w. u.w ~ :
~ ~vecu~ R~ o~.a~ ow~n reo..~u. ~tir~aw~ I
! ~ ~ . ,
i s
~ilpf~- ~OMw M~ ~!Y rONM W ~ tfA~ Mr WT L~ Mr/~ .Yw! Ow t M/Or M01 n!'/ t! OlAM OCCYNlO ~1 w! hwR. P+ M
,.~.,o..,~ _6 3 74*0 8 9 74 g •••--~4 ~ es 3~:40A
tla eece•uo ao.. tN !k- i f Y tM M~o we wqew suwi.
C~TiiC~M~?I-MEOKAI ExAMY~R OR • ON M! Yi1! Or M M011~ O~ 041w ~ ' /M MCMn / MT ~!u MOY~
fW~M~1~0~+ p~! ~00? 11t10/p 11r Mrlf11W~1pN. M tl O?M~O~~,
ww~ ottu~eo on ne o?a ~r~e w to w~ t~ubew sr~ee. -
~ ~ ~
' C~71RER-NAME ~n~t o~ rrNn . DA ~~qwr, w~, nwu
t~. B• 0 M C G u i re 0~ 0• r/ n~
''"""r+~ "°°"ss-cE"""~ 12 2 5 ~t`~r ' . ~ Ho I 1 I I ~ F ~`a .
NJ~u1l. C~Ew?T10N. IItMOYwI OR 10~1f-NAME an w awn s*.a
~awtrs. p~~-{~ p
N~ l1~. k !k. Vi~i~ I~Oa~L~ r~~ •
o~~E . ,.o.ar.... w+~t1+ M00~~. i'v( ~~'~~~~'If~'L~' s
tw a'rr 1'2 1~~ ts. IaLL~ •
v. ~612 f DMKtOR---51Gr+~MrE -yGN~T1~E ow tmo a~o~? ~tcs~~
Rev. 1970 - ~ .
~ f,; CER? 1 F 1 ED COPY •
~ . ~ ~
We heret~ ri°I fy thi above to be a true and correct copy of the
Loca L-'
~~~~~~t{b~ ~ s record on f l l e i n the Vo l u s l e County He a l th ~ a~.-;
Dep.6r'~,M,ir+~h•~'~~.~+y~fo~a Beach~ Fio~tda. ~ ~
r • _
% = * i : ~ ~ .~:n
~ ~p - ri . , ~ . : `'0 f~.: _
_ ; ~a~~~1;~un~~~* ~he~=seal of the Yolusia County Health ~yy=~
- ~4~~;;~~t~~~~'
~~~rf" 1 Xed . w - ~"o ar;-~a,
. , ~ ~ .
v s- ~ • ~ •
; --i : ~ N= A ~,°w
I ~ ~y~ r.. f '~'+y i _ ~ • I v >O
~7( ~7 - E j • Y.~ a~ei - .Z~
fj a~l.. a.
•
S !t!' ~C ~)~r'q; .
E ~~i ~~~~~~~l~w` ocs eg s rer
~ ~ ~ ~
~ Y2 1974 U• .7~Q
Oate: spu y eg s ~ar .
e 7~~ ~?JJ P1~GE
~z ~~r - ~ ,
-
~ ;
_ - _
. ~ ~ _ ~ - ~ ~ _ _