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HomeMy WebLinkAbout0856 ~ , 3U~o1 ` ' /1 ~ Ta~. ~TATt ~owwo or Nu~Tx CERTIFICATE OF DEATH . eo~es • ~•U11GU OF VIT/LL. fTAT1~TIC~ fTATt FILt NO. . FLOaID1~l . efe BI 7N NO. RCG16T11AR'! NO. P t e p r r 1~ 1. 'KAC~ ~I ~tATM GOD[ NO. 2. YWAI A[M~[MC< (~Mr 4~M Ii~a. 71 iw:~.r~~ t~~w~ N/r~ M~~wiMl ' •z~e~te~ • COUMTII a ST~T[ OOU~t~ •w~ •111 SL Cig ~l~t~~ 1. K 11ESM(MCE lw ~~e- C~nr. TovM.O~ Wurp ~s ~ua os ourM e. C~7r. ~RO11 IOCAT~ow uK+oE t~nr lwirsr •~w~Ot WSWE dri IiMITSt n,.. Ft Pierce .cs ~oD P e ~cs !a~ M~rE Oi (HMf b iM/if~l. Iire ~Erd ~f6w1 ~ STIIEET A0~011ESS NOSNT~L 011 . . "a~~T~T10" 602 I~.idrea Road 602 `fidr+a Road ~ 11~M[ ~I i1rY ~!i/it L~M DATE XwN D~1 Yt~r ~y`; «`;.r.n Y,erli,n Rudol h GiLnore ~TN Julv 21, 196? , ' i II~D[~ 1 ~(A~ {MD[a f~ MIS. rY MTE Oi NIITM ~ 1~6E (I~ ~tM1 1 . SEI[ ~ COlpl OR RACE 7. M1?~111E~ t~ MEKRM~11~1[O ~ i lYf MHWqI 11Iw~y p~w Nwn Nh- a. :~.ale '~Rate rnooMCUo a,rwau 3-31-92 75 i ~ 1~ 1 w 1~ ~a. usu~ «cw.T~ ~rn.. ?+.r ywr ~ IOS. KwOOf WSMESSO~ II~OYST~~ 11. ~MlTNKALE (81dt K fM~~AlM~d/1 1. qrad 0~ w~MT OOUMn1?t ~ •1t~ /rriy N~ti~ftik.~~~/rata[/l ~arpenter Civil Service Indiana ur?ited States ~ ~laek f~l~ 1~. ~~TNEII~S rnrE 1~. rOTNE~'S MuDEM w?rf . . F.. Gilmore ~~8 lfiavailable~ j •~~...le.r ~ If. SOtul S~CWn7t1 wD 17. IM ~ MYMATYII[ Aqrew 579-01-7875 Ellis R. TLrley 602 Midway F.Aad s ~ f~ R~YK N KATN (BaM~ ~wl~ ~t nwt /n fi~t M (S). ~~1 (t).~ IMT(11YA1 ~MF[M f rn 1 pIK(j AMO O[~TN e~r.e~er '•"T~ a"TM"'~"'~`D"'` Cerebral JFrteriosclerosis _ i •rra fft• wr[oMTC twusc f~) - t~• e~r- i r~ e.a. c.~trr.... ~~.¦r. ou~ ro ~?t - ~ •1t? iM• ~~irl /w r1~ ~ 1 s e• 1 diw~ nwr (il. • ~t~fiy !M •wIn- •eRt~lr~~ (pN n~a[ 1of. 04ETOId_`__.------- - . ~ • f tw f e 72 O ~MT ~I ObU AiA/tYf CO~i~016 COM1yMJfl~fi 10 0[~M ~Ilf 1107 QlAIIO W M~Yt pYwt[ 001r1iDl~ fiNC11 M~Mt 1(~1 . W~S AUTWSY I~~rr• •f- L /ERf011ME~0[• ~ t~r e~atA V 1R5? MOL`~ ~ A$til~ula • r~. r.r • ~ ~ ~ tos ax~MC Norr ruwv occweco (~ro ¦.r..r yn?wr i. P.rt w.e u y ~s. u.1 ~ ' •~tlw~ •w~ ~ ~ ACCM(~T SYK~OE ~KMC ~~~t- u ? ? ? i ~w •f ~ 20t 7~r[ Os !!wr ~lW~. /1tI. )'ro i ?~a~. V IMJ17~r - ` = 20/ MUtM? OCCY~11tD mr KKC ar wwr lr. I.. i~ ~r ~rr ~Nr. 7DJ d7r. TOMA. Ow tOCAiqM OOUATY STATE ~ O ' w ` MMR[ ~T ~ MOT 1~Nil[ ~ /aA. I~rb?I. YreN. ~t~ MJ~.. dt.) { MOIIR AT MOAII ~ 21. I~ff~nd~d fM I~eNa~dlrew~ _ •aI~• .!e . u`Y f ~nd A~~ w~ A,in ~/i?~ on .Tu~; 7 qr 196? , ~ O~~~A occuir~d ~t ~n en th~ d~t~ ~~~f~d ~bo~~: ~nd to tM 6~~t o! rn~ l~o~Ndp. /ro~n tM c~uNS ~t~~ed. ` ~11 tt~~• ~ MSM~TVA[ (UrM~~MfYltl ~ nODRESS 72t. W?TESWKO t• ~•n~•~• • Port St. cie Sho in . Ctr. -2 6 •Ct~lf~t~. - 23~ /Um1l.C~E~~t10u. j7~ WiE 27f MAM[OPCEMET(~~dIC~tY?Tp1? 23~. IOCAT10111LSf/.fNe't1.NtNn/// (67dt1 S ' N[rOnK~ti/tt~J/1 . est ~:em. Gardens Ft.Pierce Florida_ r. s.16~ a t~. ru~c~~? ox~cao~ s s~c~.iwc Y~t9e3s Fl~neral Ho~ ~ MT[ 1CC0. ~ WU1l ~EO I~. R[GKT~AII'S SIGNATURE , ~ ~••.~sse Saruuel D. Steele Ft.Pierce F1a. 7-25-67 Anna Lee 7enison, d.r. - . . 30i~fl1 ; . ~ ~ f € ~ h~nby oart;fy thu to b~ • ttw ~~d cotr~ct coPY fIlEO AMC RECORDED ~ ~ i litr~rs record a+ file in t!w St. lucie Gounty H~slth OvpsA- iT. LUCIE COUNTY FIA. . ~ ROGF ~ ~0~'RAS ` mN+t ~t fort PiMCe. Flaids. . ~ : CLERK C~ :CUi~ COUttT ~ (yyerning: Not vNid untess ra~sed ieal vf th~ St. luci~ ~FC~~J V~!=.; i~n 1,?3~i j~ ` Cpunty Health Oapartment is eFfixod.) : x . t - f~e 10 2 sz PH'T5 ~ ; , , , N. p. MIttER. AA. D. . ~ ~ ~ = . Counry ~F4~Ith Officar b locsl Rpisttw : ' - _ ? ~ _ , . . . ; t Ae ~ ~ / _ ~ ~ " - " • . l~ ~ ~ • ~ . i si~~ ' . i p~0~ D~pu~Y Lou! RM~srr~t I • ' t j _ 3 ~ ~ BOOK ~.v[J PAGE SvU - ~ ~ ~ . . - I ; . . ~ ¢ , ~ _ _ ~ . . . : ,