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HomeMy WebLinkAbout0745 CERTlFlCATE OF DEATH Carlsen loo2t1~9 _ . pk~~~ ~1 ~Ie+Itl~ ~wd Rc~b1111NMe $enk~e~ RATt /ILR N0. ~~c~tiF~iTM FLORIDA [r?E, O~ •RINT IM ~~~~4R~'~'~ 11[GIiT11AR•! NO. •t~tMANlNi INK rnat ~,s~ SEII OATE Oi OfAiN ~ ro«tr, ~w~, n~~? SfE MAM0100[ F01 ~~CEASEO-NAME IeSIWi110K ~ JO~ . ) I. - RACE r¦~t~, Mwq, u~~K~w MO~~N~ AGE-ut~ ~~o!~ ~ reu .ur.e~~ ~ o+~r OA~E Of ~1RM ~riw~m, N?t. CO!lMiY OEAiM / ~urwa.• ~run~ ..uti w.• ; woun ..r. •w~ / fIC. 1 ~NCN~ 1 ' 210?' . White 57 w k ~ Jul 1 Cm, iOWN. O~ IOCATION G'fATN ~ wsa~ un ~rm NOSMiAI OR OiHE! NSII U11ON-MAME ~M wO~ ~~~1~, OM ?~Mlt ur rYr?H ~ snu~. .~s o~ ao ~ Na les tv~e~~s Naple om~r dtti ~~l • STATE Of ~~lTM ~ N Mo~ u~ r•~ MW~ GT~IEN Of WHAT CW~+1~Y MARRtfO, NfVER MAR*1ED, iMViVNfi ~OUSf ~r ww, OM ~?~M ~w~e ~ ~ u . ~pywK~ ~WIOOWf~. dYORCE0IYKI~~ . L,~.,.,,p,.~. , ~Yest Vir inia • U. S. f\. ~~`idowed I~~1~ .~e ~e o~ce.uo ~~u ~CUbn Uwwl OCCU?~I~O?~ ~ are ar~e o? wo~a oo«e ow~..o ~wsr w Kw0 Oi ~l1S~ES5 OR ~WDUSiRY ~ DI~~M qp~R1Mp txf, freN u nh~f0 ~ ~ -~'~..~~l0 ~w „233-14-2462 Retired Mail Carrier r*~" - - .n cr..ce n.on wwe un ~r.m SitEEI ~NO NUM~E~ ._.,ss o~. tES10ENCE-SGtE COUaT~ C~Tr, 70WN. OR LOCwI~p+ ~ . Il~ICNt ~~1 O~ MO~ ~w Florida ~uColliei- Na les 1162 8th Terrace vo iwME~-N.u~E nn~ rwoai ~~s~ r?OiNER-MAIDEN N4ME rns~ w~a~ . „ ~Yilli~un Jennirn,s llezrien Susan Ada Winfree IN~ORMANi-NAMf tw7w:.::. i:..^.'r`~:5: _a,•_••••• e.n : cm a~orN. f~•n. tr~ Patricia L. Dearien i~n P.O. Box 1812 Na les Florida 33940 ~ART 1. pEAiH WAS UUSE~ ~Y: ~EN?fR ONtY ONE CAUSf IN II/H iOf (o~ (b), ~NO (c?) /fn/!IM ONu~ ~NO N~iM ~ Ii wr~D~~`^ Cw~1f ; ~O~ \ ``~~~~~kJ • ` ~ .s • ..s~ e o~: i COM~IIION{s 1/ AM. ~ ~ ' WM~CM 6~~~ ~Hf t0 ~S) ~ ~YrlD11~~ C~Yf! /0/~ qN IO. ~S 4 COMS~DH~MC! Or: i i f/~11MO ~NI YM~l~• ~ t11M0 C~YH l~~i , ~ ~Ati p OiNE~ SIGNMKANi CONOtTWNS~ ca+anons caaww~~.o ro a•n~ ~v~ Mot au~e~ ~o uvw oneM w ru~ ~ w M rE5 ~~~e e~rof ea+- ~ Irtf a~1 ~~~lC IN OIt~~M/wu10 GWN p OftlM ~ ~w. ~n ~ p.eboWr~ ~tUOE ~ ~ A ~ rauw, o~~, n~~? qpW INJUlr OGCURRED wNM W iMw~ tw ~ut ~ M~~n n, ner ~ , 1qqtIGOE~ OR VND~TE~M?II~ED 5 I~c M. 2Y. ~ ~70~0 ~M tN $ ~NAIl~ At WORK /LACE Oi M1VRY wort. ~~ur, s~ai~, rwcion. lOC/?TION ~ ~n~n o~ e.r.~. wo.. em o~ ~o.m, wwn? "a, ~~rton nt o~ wo~ oNKt Mna.,~x. ~wan~ e p~ 7M t~ ~ CERTIffCAiION- ..O~+~M w~ re•~ raaw wr re~~ ~r s~r re /wn •~m ou ow rrn x. ~~~ia~~?OCCUntO wn,~...o ro *ies~ ~ rHrs~cuN: ~ \ 10 ~ ~ o. r. a.~owuow, ow / ~fllNOfO ~M~ TI?. ~ ~ ~ !k. ~ l11. ~ 7b`1: M ~o uu uwua~ sr~no. ~ ~1~ O~CI~S~D ~~OY tMl OK~OfMI ~~i /W~~01I fD M~O = CERtii~UlKk1-MEUKJU EX~nutrE~ OR CORO?+ER: a. rwe ~•s~~ a~ ww a a•m Mr~ ~~~rw~~~p+ W M! WO~ ~wo/M tnf w~~Stq~~~Ow. n~ ri pNWM. ~ l oe.a. oeevueo a+ ~ o•~~ .NO oa io nN e•vun~ s~~n~. ) 1h o~ t sic,?+[o ~rOM+r, O~t,iW~ CFRT~RE~-HAME mn o~ •n..n Ai RE «^M ~ Charles S. ~tel. M Ti.D. ,,,Au st 24 1972 ~ ~ MMI~NG ADDRESS-CE~iliifR s~an o~ ¦ r o wo. em o~ .wM s.•~e ~ 831 4tli Avenue Nor . a ~ ~URUI, C~EMATION, REMOVAI CfME1E~Y OR CREMATORY-NA/Nf IOCAT~ON « p'r" s~~~~ ~ t•eu~r ~ 13urial t~~ NaPles Memorial Garcien~ It~, Naoles. F1Qri a ~ DAIE ~ rOM~M. M~ rtV 1 fUN(RAl NOME-NAME A11D ADORfSS ~ st~e~~ M~J.o. n0., C~Tr W toww, a1~t~. U~ ~ • ~ „~Au st 26, 1g72 ,,.•'Pittman runeral llome 850-6t v o~ix.E~t~~EO.~.o~.~~.t~~s«~~ V. 5.~612 fUNE fDIRE - t~ . ' REGISTRAR- GNA ~E ~ - ~ g~jjy ~ ~N Au ust 26 1972 _ R~v.1970 ty~ • ~:s . ~ ~ CERTIFIED COPY ~ I hereby certify the above to be a true and correct copy of the record on file in the Collier County Health Department at Naples, Collier County Florida. (Not valid unless the seal of the Collier County Health Department is affixed.) =:~3 ~ ~ . ~ . . F.O.. _ -4'~, ' ~ • Registrar of V al t~t~~~cu~'~~s ~A.. ~ ' ys: ~ ' Collier County, Florida C~EFr L~. ~'s;T COURT,~ ~:'fi~ ~w: e ' / . r.=rrj~7 flle r,=,`.; ' • y ~1 j• / • >3 : 1 " t j > . :s , ~ i is P ' S f-`':~. ~F_.__ y ~ ~ . Date : By ~ x4~? ' ~0 • . BOOK z37 PAGE 744 _ - - ; ~st: _ - ; - _ s. ~ . . ~ _ . _ ~ _ _