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Home My WebLink About2075 2,9,~~,~~ .1 CERT'FIED COPY k~ WE HEREBV CERTIFY THF GOPY REPROOUCEO BELOW TO BE A TRUE AND ~ORRECT COPY OF THE ORIGINAL RECORD ON FILE IN THE BUREAU OF VITAL STATISTICS OF THE STATE OF FLORIDA, pf~P.X~ r F NEALTH AND REHABILITATIVE SERVICES. OtVIS10N OF HEAITH AT JACI~SORI A. /NdT VALIO UNLE45 T?~~L ~ ' ~j~Lpp~DA CEPARTMENT OF NEALTH ANO RENAB~UTA7~VE •ERVICES. DIV1610A CF ~ a.. ;4~. . ?t , L `'qi . : . N , . ` . _ _ _ ~ P ,f, 1 ~ ~ GMdi. ~UA[AU 01 VITAL fiATqTIC• _ ~i~~ j9~' ~ . t._~~ . ~ ' " ~ ~u~,r. .h1~ , ~ ~ RAT~ wtG1~TlAw: D1e[CTOR. OIYIitOM d~' " ~ 4 - Y, - t~ h1ti-. : M[AI~N Ot/ARTMlNT 01 MEAL?M AMO ~ ~ ~ REMAlILITA7IVE sER~11CEf _ +d =~k~ ~ : . . - _ ~ ~ ` Et~TiFiCATE OF DEATH " O 3 ~ ~ 0 2 Deyadm~~d Ikalt6 rni P.~r:.~rtaf!•e Servkec lTATE RIL[ NO. ~H•~,~~ ~~.~:r, FLOAIDA ~`Q"°'^"^''^~ REG157fiAR'S h~ ~F_EwSfU--~~~f • r: +'ca~ SE~ »TE Of 9Ew!r - S~L JA2~S :'cz ALL '?-:ale , ilay 29, 1~ i~CE .n.~n. ~tcr. •renc•. ~ •SF -..s~ • •eu u•+u~ + c.. C~TE C! MY7H ~.c~.••. CCJNiY Of .?E~'•, ~ . i- -u~ s.tcn, . r~ ~ .[..s .oi ~ ~..s , •.o~.s . _ t~'hite ~ ~ ~nril 1", 1906„ ''altor. 'OwN. CR :OCA?~G?+ :t -ia_- .yoe ~ n.~..m MOSffiA~ Gi C'^_i s.S'rt~~T:C!~-~~aME ti0i N l.Twft. G'~f i*~s- •v~-.-eu _ ~ 51~~~Ir IIS NO ; DeFtmiak ~pri-.<s 1es ..21~cn County liospital _ . ~-~*E OF ~ih r ..e- . . ~ ~ZE++ Of wn~' C7lit+TRr w~RlIED r4yE~ w~~ttEO, --'SURVrvHG SlOUSE n «~ee. e~rt ..~e. :_rr~ ~W~DO~~ 7:•:.KFD ve: ~ , Penns}2vzni~ . LSA ._arTied „ Estella Sj ore _ ' - - - - - - - - w? SEG~Ri+`.~ nuM6E~t ~Su~! OCCJ?~T~Oe+ a~.c ¦~..o or wou x•.E +.s- e• +cWD OF WSU:ESS OR u+JUSTitY ' ` , ~Gft ~+f. ~~ft. t.f`~ ~!'~iFC ~ . ~ 077 005-0917 En~xir.eer _ IF.`•; _ :fStDE?+CE-S7~TE C_:+-: • ,CtTr ~pv~M, pR tOUT~O~+ '"'~'a ~+~m SiREET ANO NUM6Ei ~ vta.• •es w .ro+ ' ~Flori~a !.n -•-alton DeFuniak Snrir:: s yes ,.,Rt 1, Box 213 K F~~N(~-NA/MF .,~s- woae u~ar . N4:~MER-M.?IDEN NAME r~ast .~oo:e ..s* J~.es t~icFall i.~ Zfary Lynus nsQRM~t~fT-h.~E MAKING wDL~ ~srn~r oe ~ r.o. ao . cm w•c.~, sr.n. :a• . .,~tobert S. tkFa1~ ~„~Rt 1, Box 213-13 Deruniak Springa Florfda 32433 •~reou.un u. t~+u ~~IIi 1. OEAif1 W~S :~1c.3~ ~1f: (fn1fR Owa~ ONE UuSf iER t~f fOR (a7. IAA ~?'A (c?i 'un.t[.. oNSn .wo o~ati ~.ao~a wx ~O' ~ ~ w ~1~~ ~Z~~~t~`-Gvl . 6uf"!r 31s • eowstou . e o coMOmoNS, ..n. ~r"-~C~' - 1 ~ ~MICN ..3~ .o n~ 3'= ~ ~raeo~.et c~uu :ar. ~ e. o~.s ~ eorstovn.ee d ar~n~e ine uMOer ~~wc c.ux us~ ! k - N~R~ A. OT1ER SXsN~FCANT ~~+MS: COM01tlOw1 CONtb~ITMG s0 Of~M ttti MOt ~Y'~ iC GVSE Gnt/~ r~n ~~a A1JiOf51l i TES ~eee /~MOIMGf CPr ' 1~ p~ Mp1 1 a~~t¦ Olil~~1MMG CJw! ~ IA- ~10 E i~OMplO}~DE. UDD~EtFIY:?ED~t t N. : ra.rtw. w•. n~~ ~ MOUt ,NOW INIURT QCCl:ttf0 ~[wr[~ .unnQ o. ~w,un er •+n , w s.n-», m. ~ ~ 'i1o ~ IR M ml ~ ~~lA1t'? At w~t ~IA[E ~ .r wore. ~.a. s~n, ..ewu. IOGTIOn ~ s~en w ~r.o. .w., ert. o~ ~o.n+, sua ~ ~{I!O/? RS Ot NO / qq~ ~/D„ lt 1 Lf[Y~ 1 ~ ~ ~ ~Owa M~ ~Mt rOMM ~?s ~t/u YO vST Yw w~/~f w~M ON ~ OI~lOtD MI ntv M OEA111 OCCUpl~ at ~f! feKt. OM 1! If{711C1AN: M~ 7UJ ~00~ ~{fE! OE~M_ I~O11~7/ 04R. a!O Rl I!3! ~ 1~mNVm ~ 'J p f i 1' S5~ or a. aertesee. oue 2~ ~ectaxD .~C~ ! /~N T ~1 1 ~ Ttt ~.J 7H !b. ' t0 ot Cwua[A~ s7a~: ~ ~?I1pN- EXAM~'H C! C~OROl~ER: pc ort s o~ n~ wOUe or ot~m twt oKtctM vw ~~C,MOttnt[D tas. fi~YYt~10M W ~ODf Ii~/Ot~ AlF1~a/Ow. M if dM~O~~. nOMTN d1T rUU w00t t lta~ O~ 01 ~ O~! a1~ O 1t yrAtW W7[6. - I M Z2l. _ I ~ ~ ~ ~ CFiIiF'.Et-NM~F mre w~en b ~ ~ a~t w S~ ~+aaM. wT. eues ~ Llo d I~. ~~Cos~eaek - M.. D.: a. . ~ , ` ,f • .PV- ~.P ~'D0'~°~"~~' Pro~es one`~" dg DcFuni~c pri s: ~Floiida .~2~t33 ~ ; E:~,u. a~+?r~ ~or.s oc aAr-?~ wuaa+~ ar a•a•n•- : s..~~. ~ ~ I~, Cremation r.Southern Crematori~an ~ - JnckeoTroi2le~- Florida e~, CwTE i . EWIfRAL YGMf- At'~ ADORESS ~ s*~ss oR v.o. ..o., ert? o~ iow~s, n~?t. 32433 ~ M J-r.e ~'~1 ~~d neral Ho~-3 •Heat~ rlain-De~unia~t Sprftigs„ FIa. ~ tir ~ o~'Q.~- . . - ~ 1I14s~W ; ~ ~ ~?6~~~s~l~i, ~ ~ / ~ !N' ~ ' : $ - - - - - i ~ =;i s;= 8 ~ ~ ry~EO nNO ~Ea~r iL~- . :1. LUCIE ~ UN ~ ROCER ?0{TA~L CLERK CIRCU1T COIFIlT ~ ~ ~ RECORO YERtF1E0 ~ ~ Z~ Z 32 PM'~5 ~ ~ 299'761 '.yY BooK ~5 rACE ~7~ ~ ~ ~ ~r ~ - Y ~t ,~F . . _ .