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HomeMy WebLinkAbout0496 f~o,?~~, ~f;,~RO~ ` ~(~r~ r ~T.~l1~lE :.'4i;MTr fL1l. I~rJI~JO~ AOGtA ?r„-RjS CIERK C°. CWT COUlt1 : 11EC!3RD V~A'~tfG~.,, ~ € . ; J~u~ 6~ i t3 PN'15~ ; CERTiFICATE OF DEATH ~ t~e~A.es1 .1 Ile.li .d Re~iMvM.e Se+.1~.. srwTS F~LC No. on~as~~.TM FL08IDA r.e~ O~ ?tlNf ~N REGISTRAR•d NO. # ?F~MAN[M INK ~~s~_NA~ a~ft s[i OATEO~DEAM ~rowtw,o~r..~u~ f ~.~~~actq~s , y~~~ ~ wi 11 iam Albert Pi r :.ial e ~ June 274 i RACE ++~w. .wwo. uewc~r .r~._ AGf-us~ ?r[~ ~ n•~ wo~~ • a.. ' OwfE Of MM ~+o-aw. f01J?~ir O~ OfATH t n~ s?~cw~ ~ ~w+~. ~ ~eusi .+as ~ ~.n ' •a.++ ~ ~s. ~ j wu ~ ~ • ~ ~ l~h~i te 79 ~ - k Apri l 23.1 ~9A leon ~ ' CRV. TOwN. O~ IOC~T~ON O~ OEwT11 ..s~e ce. a~•s MOS~RAI OR OIME~ ltStIIUtION-NMtE .•o~ ~ nrw~, c~e s~re~ aw .~w~~~ ~ ~ i vrc~• .es r +o ' Yes ~ Tal ]ahassee ?lemori al Ilos i tal „ Tallahessee 1N P ~ -'-..T-_----"' ~~1/'~ ~E iN 1~Nl. OM Y?~OlN rYY! 1 Sf~tE O~ WM ~ ~ ro, ~ s., M~.r i~iR~ U~ wm~T COU+ti~ ywueE~. ?EVER ruR~ED. llSA ;»'~tar~rie~~„~~. ~tth_Gollins__-~__- - ~ , South Carol i na • . re_usrO SOCIAi S~CUR1Tr M1~MEf UStl~l OCC1~A710l~ ~rJa!'~w~ O~ ~OR rat w~nw rOft O~ TRND Oi ~USMJESS OR 1?~DllSI~`/ ~ ' ~ " n•w. ~.e e.w ~ . ` „ 264-33-0828 ~„Chie i~achinist 'iateRetd. '~,U.S. Coast ~uard • s+~-~•• eES~DEtK~-StI~Q COIM~~ U1~. iOMM_ O~ lOG?110h ••f~e cw. ~..ys StREE? ANO lIIW~ER tl r 7rec~r? ~es O~ ~O ,..Florida St. lucie ~t Ft. Pierce Yes i~.T1Ef-Ii~~ ~wP ~~M! uf/ ~t-YADEN N?ME r~Opl U1~ „ Unobtainable Unob in b - I~i'Obn~W?-N~wE wIMG ~OOESS ~s+~en w~.r.~. w. ew. w w.M. fr.K. :r~ { ,h Mrs. Ruth C. Pieper 1710 South Ave Ft. Pferce Fla. 33450,p.~. y A ~wti OEAM MIAS CAt~SED n- 1~ ~7 pE CAYSE /Et lNf fOf hL Ibl A/O (~J~ ~~n.etw o..t~~ ?..o Oe~rM i ~ - N u~fe Yyocardial~ infarction; lateral arall ~ . ~ :f . ~ , ~o.....o.,. - - - - 5 - da s _ ~ .,u a~ a~ coronary atherosclerosis Y .~~e~.n c~vs~ ~M. ~O. O~ ~f a (D~SFO~rC~ O _ aw~ t~~ft uts ~ ~ fi~t1M6 t~M •M1l~- - _ ' ` _ ' Previous myocardial inf arct ion . ~ ta~t f viz:FS S~Gh6K~wT GOt+0~i10~4 cm+.~oe ca+~r,~.~a o M... wn..or ~w.w~ w carae a~w. w.u. AUtO?SY ~ YES r~~~ /INDIN71 CON• 1~1 O~ MO~ LDl~/D IN Ofll\rIN~Nn C~Y1/ d O[?Ir ~ I eS 1~ y ~r.ak~~~ .~ar~. ~.+w~ ~OI~ MOM WIINt OCCtIlfEO ~ e.w~~ wrwe a~w~u~ r•~r i a r~~r ~i, Krr ~ Q . _ ~O~K+CE: ~ ~ ; ~ ~ ~c M 7Y ~ INANr wT M~O~C RACE Of MIIR~f wo-~. ~.+t s~an. rroaa~, tOCA1Wq ~ s~~ o~ ~ r• wo., C1T'~ 01 t0+~+. S/~M ~ 1 ~swt.?~ ws w ro~ o.~Kt Mo.~C ~M~?~ ~ ~M ~ 3 CNrsKwtqn- +u~+~ r. .e.. , •o... n.. ~.s• s......i.e. ...K w ~ oe~ao ..o. .u~. nw oe~rN oeeun~o r~~ .i.cr. o., n,e ; ~NfS1~lU1: TO ~ ~r W 1!Y WO~ ~~R~ Ot~M IMOV~t O~~t, ~r~D. M M( ~lSi ~ ~ ~ntw~N w~! ~ ~ ~ ~ Ow °r r~ [•~o.n~~r.r. oue { ~.,~..,r. 6- 8- ?4 6- 14- 74 f~ 6- 14- ?4 t~. t•M O mr c~uu~i~ s~•~~o ! s. CEtiiKnTqN-~KJ?t EtwwE~ O~ C0~0~~1 a. w~ rso o~ w .o~ o~ ~a..+ e.a ~ec»e.....s ..o..w~+ceo w.o [uww~0+ O~ 7R ~~/O~ 7! fw6nG~~0~. ~ ~ O+d~. ~ O~• ~ta• wo i w...~ ocai.s w.f ~.a a.e ~.aa. sa.a~ K~ M, ti~ , o?fn~ w.~n~ OATE S~Gri[O ~•~r.n., o::. ,eu~ ~ cEenF4•-FMME.~..~o...n., L : ~ '6r i :k 6-24-74 J. Orson Smith, Y.D. !a. ~ "•"~'~"tiD'~u-O~"~' 143~ficcos kee Road, Y~aY af'~iassee, Florid`a"32303 ~ r~ ~URIAI. UEMATION. ~EMD'VAL TE~ Of QHMATWI-NIII~ tIOCI~~10~'~ Un M qwr~ sr~~t . y~FC~n ~ _ Re~oval ~t Pierce Ce~eter,/_ i~F~.~ietc~.~l~r.ida~---------------•- , . _ ~ y : 4 RwaF~Y ?~iLrF-H~NE ar~p ~OO~ESS • +•we. o~ ~ ~ e »o . cm w ro+~, t~.n, r•r ~ ;..G/14/74 s.Culley ~ Sons P.A. 1737 Pi~nins Pd. Taiiahassee f i~. ~ ~51? ' - , ~E~.~S n/F O~~E ~fC vE0 lX~l ~fGIS1~A~ . ~ ~ r~ J f - i i ~ , . t ~ o ~a~o ~ ~ ~ ~ . ~ . . = - . : r , C' . - - : I certi that tbe above is a true aad correct co ~ t ~ cer~ifice~f~ t"Y PY . as filed vitb tbe Leoa Covaty Hsalth Dep~uctaent. (No~- v~~id _unles~_the raised seal f e aftixed . ) ' ~ ` ~ ~ o € . , • ~~~5 ~v'. ~ a+ ; . ~rl ~J y ~ ~p~il _...~.:1.G.,r~ ....t7 - ' ~ Date' Local Deputy Registrsr ~ _ ~ ~ d5R' ~~tiv ~ _ _ ~ - . _ _ - . - _ _