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HomeMy WebLinkAbout2867 i ~ . ~-~~ae~^- . . . • _ . _ . . _ . - - . ~ _ . - - - r . : _ . . • ' ~ti~.'ti-~ ~ CERTIFICATE OF DEATH ~ ~,~"~QgS ~ . Ik~t.~t.t .1 tk.lll~ .ad Rel.~Id11~.11.e Se..lce. F L O R I D A trwTC ~ N. OIYLqIkV OF IIFAI]U 111?E. OR ?RINi IN ~Nw~"~R~~ RE~i15TRAR•s NO. ~ SEI OA1E OI L~EAtM ~ ro~~M, s.r, ~ - ~ERMANINT INK OECEAStG-NAME ~~101~ ESTHER MARTHA ORTIZ :Female ~ December 5 1974 tACE .wn, Meaw, .w~K.w r.s~..~, AGE-u~T wwu ~.e~~ v.~ou ~ e•~ O~TE OF ~eRM ~ ro.w., o.~, COVNTr O? OEwM • lK. 1 WdIT1 MIIM~t ItWfl rOf. M. M01/~• rM. tt•~ 1 ' = Hhi.te- . w_ Sg - - s k - _ - una-20- 1916 Broward ` . TO~~. O~ lOGt10N OEATM waw ce+r w.~~~ MpSrlTwl OR OTME~ NSTITUt10N- ~M w~ w u+w~. onrt fnt~t we «wut~ ~ wcw. n~ w .~o ' ~ , Fort Lauderdale Yes a Hol Cross Hos ital ~ St~tE Of WtM ~ w Mor r. v.i..., ..~..t G11tEN OF wMAT COUNiR1f M1AtR~ED. ?~tEvf! MAtRiEO. SURVNr~G S~WSE ~r ~rut. 6ne .u~»tw wue ~ tAw~+~ WIOOWEO. OIVORGEO ~ sncrv ~ ~~u~ ~ Vir inia USA N k'idowed _ ~ vN[te eKUSte SOC~?l SECVRItY MlWE! USUAI OCCUrAiION ~vo1 u.~ o~ rOU e0»t au~w6 roa O~ KMA Of MlSINESS OR INDUSTRY • uvee. r ee•a occw~n w 1r0~M0 UM. MM M YMfO 1 283-10-4862 Housewife Own Hone - ` ~~yoa.ct uroa ..~q an uras St~EET /wC MU~E! A~s~ RESIpENCE-SiwTE COVNiII diY, fOwN. OR IOCwT10N _ ~ ~wun ns e~ Mo ~a. Florida ~.r. Brovard ~~Fort Lauderdale ~..Yes 1460 NE 56 Court fATMER-NAME r~W r~Opf uW MOiNEt-MMOfN N~ME ~u3t wOx! ~ :~ft ~s Jose h Prochazka u. Mar Svetli:c IWORM~NT-?iAME MAl1HG AOGRESS ~uua a~_e.e. ~.o., e+. w w.n., u.a. er~ _ Gus Prochazka ~ Westlake, Ohio ' IART 1. OEA1M WwS GAU:EO ~11: (ENfER W4r W~f GtUSE Ifi lWE fOR !o~, {A1. MrC (c~ s~~ver.a o•~.s~~ .'.i ~e. ~ ~ fl D A!t~ RE~OROED ~ ~ { ~2;~~~~ c ~ ~ - r- LI couNTY F~~. ` • ~"r~ a~ - • - c~EF:~ c~=c~~~T coua ~r°r~iiMto°:eiis/w (~1 RFCARr~tic^i~?E~~.~~ Ytrfp~t~ t~uf! b~, OY! ~O. p b~ CONflOMK! OI: w f1~TIN6 ~M~ yMOlf• ¦r._ ~ 12 39 PM'~~ rnwo e~vse us+ kl ?I?tt IL OtMER SIGNYICANT CpdWtlONS: ~~na.i eo.we~nwo ~o ww~ ~~n rq~ ~curw a urse eM.. w~ur ~ a~ ~?U~aS1? IF ~ES .eee •~.~,~ss c_ ~ns w ao~ s~ou~o e~:u.~..~~ u. M O~~~w Iw N o Hf ~ _ ~~~1 A ~a.o~eM, wr,nu~ ppW IHIUtr OCCURREO ~~~t IYtW! W ~WYf~ ~N IYt 1 Ot ~d~ Mt~ ~~t . ; ~ . E ~ t0~ 11~ 11l tM 111JURV AT wOR~c tIACE Of It~luRtt .r w.e, r..r, snen, r•aw•, lOC/?iIO~N ~ suea w~s.~_ .a., an o~ ro.rn, ~•tt ~ If~eC~n tts oa qo~ oNKa hoG_.tK. ~srtt~n~ ~ " - 7h 7~1. . „1 ~~~iq~- „a,i~ yr ~e~a .,o.,u~ ~u,~ ~MO 4!T y~l Mr/MI\ ~11~r! OM ~ ~r/ao wr .+nr we oewtw oteuee[o +.e •~.c! L. -.t , ~Mtr3KU?r: TO roMtN w• ~e~ soor ru~e~ a•n~. ~..ou~~ o.w.+•+ -~t ~es ~ ~ ~neaoto rwe C - t~.. ««.:~o ..o.. t"% - ~:n Z 2 / 5 7 4 ` - 7~ ~u :ib : 1 .l A M. O M! G.ft f~l'~'t ~ . CEIi~ICATION-MEDCAI EIIMtiNER OR CORONER~ o.. tw! ~•s~s d w~t wow a ocwa Ml OK(OtMt ~~f ~~Or~OUnCEO Ot~p uu.w+~no.. or *~t ww ~+.oio~ tw w.ut~.~o«. w. .n o~.+w... % ro.~rw wr nu ~wu~ ~ oe.m ou~~no o•. w~e o•rt ~?.o we w rw[ u~ouo~ suno_ x m CEttlfh'f-NAME mn ot r~wA - 51GNA E eteue w ntu A SIW~E.7 ~ro.~•• ,s•r~ .!1?. . ~ ~-1 f~•. • ~ ~L. ~f`; ~y/ !k MAR~+G AOOitESS- ~ uaei o~ ...o ..o un a r u•n tu ~ -1 v i' ~ • i % L?~ !J : ND~C.~ S ~ C~ . WRIAI, CRP~v?T~ON, eEMOVwI `CFNtEifRr p1t CAEiw?TO~iY-h~E lOCwt~ON u~ o~ q..+ st:re ~s~etrn~ ,M Burial :,Lauderd~le Mem. Park :.~Fort Lauderdale, Florida O~iE ~..p~n~, wr, r[.r~ FUNERAI HpME=Ni.Mf i?.U ~DCRESS : sta~~ o~ ~.~_o. Mo.. em o~ to.N, sr~*e, u?+ C~~ w Dec. 7 1974 ,~.JORDAh FUNEFaL Y.Q:1E, 5110 I3. Federal Hwy.Ft. Laud.FL Y. 5. l612 fUNE l DtIKTOR- •pME REGiSiNAR-S1Grv F . ~~;E RECt1~t7 ~t IOCAt aEG~;-a.a Rev.1970 t~ ~ ~ ~ . ~-y~-+ n. /~'J . ~ • iJ -,/i~l tw ~ ~ / ~ CERTIFIED COPY ~ . . "-tr - ~ ~ I here ~i ~~the al~ove ta be a true and correct copy of the Iucal • . ~G~ i,~ y- ~ - ~ . : , Regi_~~s r ~~ti :i'~fle in the Broward County Henlth Department at , » , ~ tir t P'~I Y''~ E~ For~ .~id~~yd~' ~1q~ y • : t:..1a ~ T, ~ i ~ ; - ;,.~t4, < ....r,,,~;,~~ , , t (K`~~in - Not=:tira~~~"bnless raised seal of the Broward County Health ? '~,~ri~F~tlhf, ' - ~ ` ~ ~ ~s affixed. ) ! .~t~.~ 12-10-.7ji °~~t~~~'~ _ _ Cou ty Health Offi r and Local Registrar , UR ~ ~ 6n~~ 234 ~,,~f 2565 f Deputy Loc Registrar E - =r - - - - i~ r'_" _ ~ s _ _r >3' ~