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HomeMy WebLinkAbout0698 _ ~ _ . . • - _ _ . ~8b68. . _.r . CERTIFICATE OF DEATH ~ATt Fllt NO. ; • pep.r~oe.~ .I I Ie.IJ~ .ao Re4+i..Luti.e Ser.kes . IM~'~~ ~ tp~LTM F L O S I D A REGIfT1~AR•! NO. w~r ~ wn?~e.~s ~ fr~E. O~ fflNt IN u~~ siY OAiE Of OEATN ~ roNiw. ~•r, •e~~ ~ . MtMAM[Ni INK an+ fH M1~OIOOt F0~ ~E~~-~AME Z. l ~siwcnMb J~~,] E RwCE •wn. M~ow. ~rucu. wM~M, AGF-usr ww~ ~~u~ u.~w~ ~ wr D~E Of WIN ~+o.w. w~. C01N1i11 d OEAiH ~K. « .o~. «n ~ 03-O1-90 ~ ~~4 ~ ~ ..w cm .~.ns MOS?rtwl OR OTNEt NSirttRqN- ~ r..a w e~w~. o+.~ swn a,e ..wre~ ~ 6602 cm. rowr+. oa iocwTw~+ oE~rH o..w F~OItT PIII~ YES DO~A F~ PIIIi(~ N~+10R?AL n s~N~~ ~ Y~'1/~, OM MNM MI1/i! 1 ST~IE W MtM ~ M..or ~.w... •••r~ dT1IEN Of WHAt C01Mi~~ ~ wt+~ ~ ~~T~ ~S+ • D~Tt~~ c°trnn~ ~ ~ ~riJl.Va~w~ C~LYYi[Y~L~ U.A.S. Y1VY YtipMCf rMN OK4flO ~yy SECW~ rMM1~ER USUAI OCCUtAT10N ~Gti aw~ p w'O~c 00~+! oMwO rDf~ O~ [WO Of MnMESS OR uvt~. r~a~r w~art+6 we. n~•. o nu~ro ~ ~y___~,.~,~ iv~~ r-'i~iL o,,,. 221-OS-9024 RFAL ~TE ~uKt~rx:r: n.. ~ewn.ce r?o.e 't ~+sw~ cw. ar.ws snEEi ANO ?~U++~E~ Crtr. iOWH. Ol IOCATIO~+ ~rasq~+. RES1pEHCE-STA~E GOVni11 ~ ~vKM+ nf O~ MD ,N FI~ ~y sr. i~JCIE - 14F(~'T riII~E YFS 940 sURISE 8Lw uA MOTNEt-MADEN NAME ~~W rMU uf~ /ATMER-NU~E i~W ~iOO~~ IS ~ ~ l7ClL~l~J+7 I1~ ~WORwWT-N~ME ~rwtwG wDOtfSS ~Nr~~ o~ ~.r.e. w.. c~ w w.~.. s~.n. sr~ n. IQ~R7C JANL FIARRIS ~n 940 S[TI~ISE ~BG riut OEwt» ww5 G?USED ~r: lEatE~ ONtr Owf GuSE ~E+ u+E ~ hl f?L ~ kq ~~nnu. o«s~r ~w a.u~ 1/ ~..ra~ unw i ~°f ~ ~ . ` I ~ COwOtilOwf. 1~ ~M. ' ~MICM G~Y~ •n~ w (bl . 1 ,~1 IYr~01~if C~Yf! IM. aM q. p~ y~ CpM7~qY l W. ~ V. ~I~lIMO ~w~ YM~I~- I ~nMO C~YM ~ (t~ i /W(p~Slf Y ~'f5 ~i~~ r~ue~wGS Co+ ?w!i OiME11 SI~?aYK/wi CONO~TqHS~ o-.a~ s o.~~un.~c ~o wm wi ro* uune w uvx crnw w ru+ ~ w~ ~ns o~ wi s~a~eo x. ~eiu.uwuw cwa~ M OI~IM ~6 V Iw ~b . i A ~ rpMrw, M~, te~~ ~ MOW MOW INW\~ ~CCU~IED ~ eip~ w~ «~~Nn ~w ?~~t . G I~~1 w. we~ U 1 ~ ( ~CGDEN-f, -Sll~CrJE i ~ pl ~XDEiEWwEO ' ~ E3 ~ ' ~ M ~ ~NJUtY AT wORK ?uCC OF wwtr w.a. sTrn, ••c.a.. totwnOn ~ su~n w~.~.~. •w., cm a so~rw. u•n ~ ~ a 1tMC~n ~!1 W~1 OMK~ MOG..eK. IVtC~t ~ ~ ' ~ . ~ ..,o usr s~. w...wr,~m a+ . wioa .o~ .r~ en o[wtw octun[~ w.e r.nce. w~e ~ . CEIrtIf~U~~p+- ~nu ' .wa. o.r ~W p„rw w. .tu we~ .nu ~ ~.ow~ F~ e.a. .w. w r ~esr ?MrSKuu: TO ~ ~ ~r r~ anO~ntoGa. YN~ ! ~~~nw0(o rre /GrL ~ ~71~. I ~ 7N. ~ 71~. ~ 4 Ml t0 u~! Cw7t+» fLRC. OIQ~3eD I~Or lY ~tt? ~ Iw~ Y!C!0!M r~3 ~nW~W~+CfO Ol~O ~ CERtYKwTqn-MEWCAI EXw~fR O~ COiOt~Ei: w nn Ns~s a rw~ ww w a..n ' ~a q,• n•~ ~..rr.~~ M e~ ~W~ w/w rw w.~srr.~no«. e. w~.w... ` o1~w~ OCCWMO Ow M MR ~.o OM q ma UvSfO~ s~~HO. Mli 721 ' _ ~ SK~'1w.eME auee o~ nr ~A SK,t+EO ~+ww., a.r, rW ~ ` . ~ CE~t~f~f11 E .me . ¦ ~ ty , ~ t~ ~ussnl~"~,. Counts, I~. D. „ - S,„~.a...0 ~A. .W,. ~ j ~ -`~`e"~aware Avenue Fort Pierce Fl~~da 4n«~ W,~ ~ ~ t~~~u. u~rq~.. ~tMov~u t~T~r o~ c.~~roer-N~wr ~ ~ N. F~~[' P 24 tu p~y ~ OwTE r.w~~. •w~ fUNEt/~ NA4~ ~I~O A~O~FSS siue+ o~ ~~.o. .o tm w~o.w. ~r•it. t~r ~ 77J,4'J~ ' ~ ~ 5-10-74 n.. FSR~32AL IiC~iE 901 N. yth St. FOdtT PI~CE .u o. .aceneo ww ~cawTU. ~ r. s. s612 F q s'c"'"i",~r ~t ~ ~z-~j ~ -s~c++~?n:.~ _ a~. ~ 1974 ~ € ~ 1~•v.19~o n? . !-L`i~_,y u.. _ ~ i~ • yy R,i ;,~~ncn .rl • STLWC+! t i~UMTY FIA. ~,~v ~}~~y ~tify thb to bo s trw and corr~ct copY of th~ Loca? aO,E, ;?'~~A~ At ~(V ' file in tM St. lucie County H~alth D~eA- Ct~PK ;;~.;tT C U c~' ~ Rvpi~trars retotd on ^ , Ftaida. q fr.^•"" : = ~";f _ ~ m~nt ~t Fo~ P No,ve~~d unless raise~i ~eal of ths St. Lix?~ ~ 25 ~M ~~5 ` ~ ~M~~~: rtment is affixed.) ~!!IN ~ : ~ . ~ County HeaNh Depe ~QC c p ; C7VV0 . N. D. MIIIER, M. D. . • . . _ ty Hwlth Off~ctr 3 Locs~ R~Qistret „ ~ I _ ~ r' ~ - `'i ~ p~pWy Locsl RMisrror ~ ~ . ° R 235 69? ~ BOOK FAGE ~ ~ ~ _ - _ - . ; ~