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HomeMy WebLinkAbout1327 ~ ~ CERTIFICATE OF DEATH • . ' t~..i~~ .,~a R~i,.i.~~~~.~~.. s.,.k., . F L O R I D A tTATt ~o. ++y _ i~~~wK+~x~n~~n~ 7QL~~ !•~1~~~ T~~E p~ Ii•M~ n~ ~~~'~'~w•~ IiJa.7V ~tGItT11~w f MO n~r~ia~n ~N~c acl.seo-?+~we .,.u .«u . ~.s~ ~ 1Ef ~ SEa Wl! p OEwtw • .o.~r. ~ ~ THOMAS ::ORP~TT~ FLF3•tItIG ' : ~.tAI.E , oCTO~: P. L 1974 ` ~/1CE +toq. Vf4C~M MWYM~ •Gt-i~w + w.wi r.a~ OA!! d ~N111 ~.o~. w•. COtR~n? W OE/?tw nc ~ wa~r. ~ ' M~ • .~u~~ +oi a.s ~.aw~ •tu ~ . ~~rxrrE w "~5~ N ~ ' ~ :wY i5 1917 a~va~ Gm. 10~rN. W lOG?I~ON Oi OEATN ..w~ cw~ ~~.ws NOS~r?i O~ OtMER Wl -N .r ro~ u. ~~~.e~. aen +•~n uwp ~ i ~ ~ Vttwr q1 p ~p ~ . s ~ PA: RICY. AIR~ FORCL B1~E t:0 j„ L'SAF HOSPITAL PATRICK ~ Sr~rE O~ WrM ~ r.m GTIZEN O~ ww?t COUM~r ~ W~RdEO. ?tVEf MARUEO. SU~rIVfK'i S~OUSE ro ww~ r.*n a?w.~ r~r~ ~ cow.m ~ ! wl00wE0. W~O~CEO ~ wc+~ ~ ~ •~•~»c• ~ St~tJii{ CAROLIiIA ~ U.S_.A. `:u •'.ARR_~D n_~iELF.~ZRO,~~If'+LL__---- ~~+n eece~ws ,~•n K•r SOG~ii SECUbTi N1?WEe USW?L OCCilrwtiplr ~a~w .~a a.~. s.rw ww.a ~ a KY+D Of ~usM+lSS O~ wQtlSTtt oCC~~N~ w. . op~w0 tM~. Mw u YqN . :~~«K 2~+~-03- 2 3 ~a SENIOR 2•fASTER Si~v:A21T RET ~~U,lI~ED S"~'ATES AIit- FORCE •w.so... tES~DENCE-Sr~?E COUNTII Cltl?. tOwN. O~ tOUT~OM w~sw un u.m SI~EEt AND +niµ~E~ ~ ~inun •ta o~ wo ~a FLO~IDA ~o BREVARD i« PAI1~ 3AY ,u Yc~s ,w 878 S~ kPOLIA CIRCL~ il1tME~-NAME ntst • ~uoo~e utt MOiNEf-MAIDEN NAME ~Mir .~.oa~ us~ „ NSORRETl'E OCDIIt F'LE i; LII,LIAN I:~~ ~ BOLT ~wORM~t+i-r~tnME . awlMG ADGRESS ~s+~n~ w~.e..w. cwn w w..•, i+.n. I~'~t5. HEL~T FI.~TI*IG Q 8 SE APO R P d A ?~ui i p~TM wwS GWSE~ ar: ~E+~?[~ aur a+E uuSE ~ NA fsL ~ k1) ::.:•ew o..w: .u+.~ 11 wra.e uvse . . • , a~ t~TASTATIC CARCZiiGt~A OF COLON ' 3 YEARS wr . • . ~ toMNnowf, n ~~n. ~ - rM~cw o~r! ~~s! t0 ~ - - ~a~lM~tE C~Yft WI. ~ ro. « y ~ ~y~~~ • {T~~1N0 ~wi YM~~~- ?nwo t~~N 1Mt . , 'R ~t~ ~~tT O~ER S1GN~fIC~T CONOIt~01aS: ea~anaa eawrNm..~ a se..~ w~.~w ~n.~es to eww a~.a. w•.n ~ N~ /WfOK~ " !i YES ~~R hMLIMO~ COM' 'k ~ - im a~•o~ vpeee~* Mnuwww uww ~ iw 2I0 iw. I p.~~ wCC10t ~rOM~. M?, rW ~ 1[Ml~ M~~IIr p 1~1lY~1 IM ~Yt 1 O~ /yt N~ w!r ~ai+~uo[, oe uw~r[wu~co MOw IN11lRr OCCUttED _ ~M 7N. 11t M. !Y INIU~Y AT WOtR rtACE Of ~iJURr Mo.~e. ~.o. s..u~, r.c+on. 1OU110t+ ~ snen w u.~. no., an w a.n.. u.n ~ - ~ tnon n i w.a ~ ow~ca Msa., ac. ~ vecws ~ ~ ~M. 1M 1~1 t urtrKwtqa- •w+¦ n.. .o.~*. .u, w.e w~ s.w ~.?~.?~e oM ~ wid6xi6 .Kr w~ oewrN occwno •r ¦n .ua. w re ' rwrsK~wri: rwm u ~on ~nu eeww. ,woa~ oae. w. ~v wt u~t ; ;:~~..~o~ DEC 26, 1973TO,~ Oc.'r 4~ 19'tk OGT 4, 197~+ :u. DZD 2: 4SP~. o~'. CE[i1F1G~~-µEDICAI EXAMNER OR CORONER: W+ me Ml~s or M! ~ a a.s Me eeceoer.r .u wowou~cw o ~u+.ruroM a aR ~oe. ua/o~ r~ wmsha.*~ou. n. r. or..~a., rwn~ a• • n•~ ww H~n~ Ott~a~t0 d+ O~R w0 OY[ p ~e! 4VlE~Y ~i~tl0. ; ~ t7„ ~ m v - : CEROf~Et-NM~E ~m[ o~ rann . ' aeue w mu: A irw+M. w~..w~ STAc+I.~"'Y A ROSENBERG ,'•iA.T USAF M.C n~ ~.=C ~t' M. D. OCT 4 1974 MJ1~MG ADORESS-CERili1ER s~ao w~~.e .w. e~n a+o+.. se~R ~a USP.F HOSPITAL PATRTC'r: P TRICK AFB FLA 2 ~ {Utlwl. CREMATqM. REMOVAI CFMETER1f OR CREMATORt-lfM~E IOCATION c~n w~o... . sun ~ HlCV~ ~ ,N R~moval ,arlinqton Nationai Cem Fto My~rs, Arlinc~ton~ Co, Va. O~~f ~ rwrw. wr, n~u fUnERwI NOME-NM~E ~?+O 4DORfSS ~ fnea o~ ~.r.o. ..o.. em w~ov+~. sr~n. o? ~ Gct.8, 1974 „~avis FunAral Hor~e,36~.Brevard Dr,N,elt~ourne,Fla.3Z935 Y, 5. ~612 ~UNE Dq -SK.N~NlE REG~STfAR..-SiGrr~ry/t~ r . twrt uctirto n~ow ~to~srw Q~v.1970 ~ - 818 ~ _'e~_ •.r,•{~i. ,<n.~~:! .l~ ~ • T'•'~ - I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRF~CT COPY OF T~ RECURD ON FILE IN THE LOCAL REGISTRAR'S OFFICE IN THE BREVARD COUNTY HEALTH D~ARTMENT. .,T;k (Not valid unless the seal of the Brevard County Health Department ia affixed.) ' /l,~- 1 - _ _ Local Registr ocT 9 ~y~a Date b Seal ' • Deputy Regis er e ~ - B~~ 23~ ~ i3~~1 . y, " ~ _ . ~ - - , ~ ~