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HomeMy WebLinkAbout1904 • ~J=_PAR7~AENT OF HEAITN Af3D REHASiLITATIVE SERVtCE~ s~2• STATE OF FLORIDA y • ` ~ . D1ViSlON OF HEALTH BOOK PAGE '~961C~ Alachua County Health Department Telephone (904) 37&5321 P. O. Box 1327. Gain.~svitle. F!onda 32602 CERTiFlCATE OF DEATH Urp.rt.e~1 oi He.h6 ,aJ Reh.blln.d.e Seerice. sr~?T= flu leo. a~~oF?+~?~n+ FLORIDA ?fr~+T fN r~"vw?~R."e° RfG13T7~AR•! NO. : e n M~~M IMX CEC~wSA-MwE npt rwae i.s~ , ~YCIOOL ~';t SFi OATF Of QfAiN ~ •oMt., o.., ~e.~ ~ ~ RILEY COBERT HE.IRY t rL~I.E ~ JA~~IUARY 6 1975 RaCE +~.n. «eero. ~•w~~tu~ ~+w.r, AGE-w~ ~~o:~ ~ reu .+~+ce~ ~ o.r D~iE Of i~qTM e.o»rM. e•.. CaN~Ty p~ pEaM iK ~ YtC~n1 ~~~7we~t Irt~q~ rOf. O~IS ~.OY~f ..w. R~~1 , trTiITE 47 A ~ AUG. 10 19?7 ALACHUA C~TY, !OWN, Ot LCCA~ICN CF DEAM ~-s-e~ u*+~ tuan HOS~ttAt 02 O'1+E2 WSiiiUTlON-N4~+F ~ u..or t~nta, ene sat~+ a.r w.ua ~ t; ~ y S~K~~ ~!S Ot w0 71 C~I~i~JVILL~ 1'ES r~ V.A. HOSPITAL . STAiE vf E~tiM .'oi u s.~.. ~a~.~ UTiZBd Cf WMAT COUNTlt11 w.AitMED. t+EvsR Mui71ED. SUiVIVO~K,' S?OUSF ;~r w.M. O:re .uwe~+ nw ~ oou,.~~ W~00`wf0. Crv08CFD ~ veer?~ a,~.~, ~ FLORL~A U. S. A. u MaRRIED l~. ELE~~10R PLATT -en xeuato ~~~1 SsCUi~tV f+u~+sE~t Uw~l OCtlJrwttOw :uve ea.s w v.o.a ao..e o~u»e .•os. o. ~-o ..um Kit~l~ O~ lUSWfSS Olt IN~VST~Y - : _ erro •.ou~.w uR, ae« remto ~ ,2 41'+ 24 ~015 ELECTRICIAN ,n ELECTRICAL s"~^. F'_S7DE!+CE-ST~TF COUNTY C1T11. iOwN, Ot IOUi~ON ~s~fle u*r ~~m STREET wND NU~+~ : . ~ t vxn? ris oe MO ~ ! , Tw ZORIDA u~ VOLUS IA ~a DII.TOIJA ~u YES ea 601 merriaac s t. ' _ fAihFA-NA.ME r.rfi WJ~v! uSt MOi?!ER-MAIO:H N4M[ ~~aSi r~eqt Wr . 'i - :i RII.EY C03ERT HE~'RY SR. ';i. GERTP.UDE COFFEE i n 1 ~i 1~RJ1ilu+G AGORESS lu~en o~ 4r.y. Mo., em o4 ro»n. sr.a, tr? IJ ~ T.A. CORDS m ARC~R R4AD GAINESVILLE, FLOBIDA 3?602 ~ iwaT DEAiM W~S LAUSEO 6~: ~ [FNTfIt ON[Y O.NF UUSf Pff tWf fOR (uL (b). ANO [ wriso~~+u. ~w w ~ ( i un.H.. o»sn .r oe.tw 1~ wrlWR CwYSt ~ ST. LUC~E ~OU T S ~ te~ HEPATIC C~'iA ROGE~ POITRAS 5 De~YS ~ 4 . • • N - . ~ CO'~DITIO~~. ~M~. ~ RECOF? YEQ~c~cp~~,~„~ .~s. ~o ~ tb~ I.AEc~iNEC S CIRRITOSIS S YEARS ~rrlD~~i! C~YS~ :0~, py~ f0, W wf ~ CO+~ftOyl~+C! O~: ~ ' • ft~urG ~w! 1wDif- . ~Q ~ ~ i ~ ~ ~n»a c~ ~ urs~ , /Va/9b19 ~ ~O I ~ ~ ~ J 7}-d^ ~C~ - . ?Ali il. OTM~_R S+GN~ifC~u~1T CONO+TICIVS: eo.~o.ny.s co.wawn..~ q pe•n~ w~ no~ ~eur~o io u+st ~.~+e+ r.. rwrr ~~o~ ~~T ~ rE5 re~e nro~wot tw? ~ e ns a.w~ oap eo M+ oen...~.u+.e ewse t' ' i~. tw. ' ~:-c; . - - wCC~GFwt. AiK10E Of Dw it~U1Mr ~..o~.rN. w~, ~e•~ ~ MOUR MpW Irifl/RT OCCtiRREO ~ t..re~ wave w~rwn ~M r.fr ~ o~ r~n n, r~ ~ 1 Uy(~ MO.NIC Ot ~WftEtM~++ED ~,-E~k t~1e~..' ~ _ ~ :Oc ~y. ;y Ii ~/Q~.,'.•i.;:; - ~ i • INH1R AT WOR1C ?LACE Of INH1Rt wr nor. ~•ar, sr~en, r,no~r, IOCAiION ~ s*ee[r w~.~.o. .w., un o~ ro~, u~n ~ ~ IsM[~n rts•o~ r+0~ O~K! ~iOG..tx. ~LKbr~ ?i 7~1. :~F t0l. ;1 CEf?Ii1CATf~N- ~Owm O~~ R~t rOwM p~~ ~l~~ ;Q(k~~{~~~~~J~~' t~~ 1 p0/DW M01 v~lw n! OlAM OCCUtltO ~t 1~! hKt, qw iM rMSSK~+~.~~ TO -..Tw-~r- i ~e.v soe. .mr oe~n~. u.ow~ o.-~, ~.o, w~re ~u ;;~;:;w ro Jan. 4 1975 Jan. 6, 1975 n, t,~ NOT ,,.11:_45pG. ;:',~,,,"°v;~;:~ ~ CctT~f~C.?7qN-••FD~GI E]UM+tvER OR CJKM~ER or T..r a.;•s r~r „o„~ w.r ~~e oeeex+. w.s ?+o.+ov..cee otwo turw.-0+0•'r! fCT u,9'O~ sn! ~wl1•+G~•~0~+, w uI C+:rq.~, ' rC~Aw o~t ~t.a MOY~ . O/~:w OCC:.~~M M~+! D~'! aw0 6uf t0 7~rf _aJlf~l~ Si~nD. ~ n, 11:45 M Janua 6 197~ 11:45 p: M. CEailHea-N~uf :n+e o~ .n•.n SK'+nMTti oee~ee w sm~ ~~Tf SIGN'EO ~•wn., o..,.e~~~ S: LD£Y LO?~'GLEY III, M.D. 7,,:; ~ ~ ' - ~ : ; . , •1 ,i ~ i-- ~ 1- ` a~~'~~~5~'~~`lIT+ISTR.4TIOV I~~JSPIT~.at A:iCHER .°.OaD `G~_. aS~J~,LE, FI,A 3~0?_ ~ l~iYl~,l. UtF!MT~ON. 9~.rOVAI CEME1FtY C~E/.1A~O~lY-NAMF [~AilOH' (~n O~ 77++ S+~'! 'k~"_ . Sifi~~ ~ ?.....~OV~?1. ~.r :a r1ELB0UR.~ FLORIDA ~ II~~E ~..o~.~+ •e.s~ FUNfRAI HOyf-NAMF ANp AODIESS ~ sr~en o~ r~ o wo u•. o~ ro~++ sr.r ~ ~ ~ J~:~. 7, 197~ BROSr~iLEE FtP•YER~ HOME t:~"I.BOi~:c.`FE ~~OR~A ts. ~ ~ ~ . . ~ ~ : ~ :.,~v~~.f O~!iCTC ~:~,+.atu~' : ~f - ~iiMf i • ~ o.*t -Ew.a ~ ~te/is~re.• ~ - . ~ . 71i i ~ - '.i"~ s~. 'i,i G~ f ~ 7A ( / y . ~ l~ -~'gT: ~ `'~\~~..~v~i .~(•j'/',~Y ~ '•t_' : •••,t ~~~'~V`•~•:~~~%~~• I H°ZE3Y CERTIFY THE ABO{~ •T.C~~ ~Q~ ~~D EXr1CT COPY OF THE DE~TH ? K ~ . A?s I Cr.RTIFIC~TE FILEt~ LN 'THIS~ ~ ~t'~!~ i ~ 1 0 19iG - . ' , ~ JAN ;~,..;r;~ { - ; ~ t ~ p ~ ~~c ~C~ (D~TE) ~....:~~~~A. DELISLE, DEPV'rY REGISTt`~R ~ DQ(~K J PAbt ~ titi 1`'1 ~ 1 - ~ - _ . r~