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HomeMy WebLinkAbout0935 / ~~0 CERTIFICATE OF DEATI-i • , p,r~,.N.w,.~ .I Ik.l~6 ~nd Roh~l~l~~~~ire ~..k~. tTA7E F~~c Ho. - ,,,~~~~R:.~ FLORIDA REGISTRAN'S No. 401 lr?t. OR ~~INT IN •?[aMAN[N? INK DECfwSED-?~AME r'•s~ "'°°•e SE¦ DATf O~ DE~in '+o«.., e.., ~ SEE Iiat0100[ fOl ~ ,,,s~~~„o,~ ~ ~(p~~((~ gFX,~Et , Fenale ! ~ 4 1974 tACE ~q. w~6q. ~+~~K~w wO~~w, AGE-~N~ u.~~a_~~p• ~u.wu ~ o DAiE O~ NtM ~rOnTr. o~~. ~COUNIY Oi OfATN ,~c is?~c~~~ ~'ll~ ~~~'~~.i.n~ ..os ~ w.a `..w.s j~;u~/. 3~~19~0 I~~ ~1C1@ ~ 66~2 ~ ~ ~tit, TOM~N. O~ lOCA110H Oi OEAM waw~ un ~~..m NpSr7Twl O! OfNE~ ihSTt7UT~ON-NAMf ~u no+ u~~•, uv~ a~YU .~o ..ur~1~ ~ S~ICw~ ~!1 O~ w0 Fort Pierce Yes Ft. Pieroe M~arorial Sospital n S/~iE d WRM ~o ..o~ w v s•.. w..~ CITIjEN Oi WMAi COUr1~RY ~wRR~FD. t+EvEQ wtwttl~- E~--iS~n~aG 51'OUSE ~w ~+w~. cnt .u~w~~ ww ~ • • . tOwm~ ~WW~Y~ DNO fO~vetr~~ ~e u „su.~ asc~.~a ~ ~l~TdTll.d ~ U•.~ ~ 1~! - -..ne ace.we - ~~+eo. + a.w. SOC~µ SECUtfiY NUMiEf USUwI OCCWAt~O~+ ~ w.~ .wo o. rwa oa+~ uw~•w ••oa~ or KWD OF WS~t:fSS O~ 1?OUSTlY OccuN10 w ~x~. lr~w u ~~~~~to ~ 263-82-2278 ~ .e~~ov.tt nroa wy~q cm ~rns ST~EET ANO NUWEIt .o.~»~o... tfSWENCE-StAtf COU?+ir f~Tr. TOwN. O~ tOCwilOri ~„~c....es w w~ ,hFlorida ,y St. Iucie 14 Port St. Iucie Y es 212 E. Arbor Avenue iAl/1f~-NAINE .~n~ ..wai i.s~ MOTMEt-M4WfN H11MF ~as~ W~~ "s* p~ Auy i„ Jean~e . rlacvi rar u IHfWM~wi-rv~MF ;w~MU+G wGGRESS ~s~~~n o~ ~ ~.o. ..o. cm o~ ~o.~, s,.u. ~u~ N Jeane Pirkl 212 E. Arbar Ave., Fort St. Iucie, Fla. 3 3 4 5 2 ....o.~.., ?w~T 1. pEAM Ww5 UUSED ~ENIf~ OtitY (Nlf GUSE ~Ee lWf f02 (el. ib), wdD (al) ~er.u« o«sa ~~.o a•~w ~ v w.ro~+n cwu S: • A _ ~ ~~.~M.1~.6/Vf~ , ~ «A. 6GT7~a • c ..s~an..c~ o. ~ Vp,wO~~lOn1. ~r ~M. _ I ~ ~~j/G ~ ~cw 4~~1 •~f~ ro ( (p) ~.k~~~ ~ ~rrim•+~ c.vs~ ia, ~ sw ro. ~.s. ca.uaw»u a ~ . r s~•~~..o ~w~ YMH~- L.~ 1~~M0 C~Vf~ 1~f1 ~ t • (tS C] wUiO?SV tF rES ~~.e r~~c~.+cs co~- , ~ /wRi M OT~E~ SIGNMK~uiT COMWiIONS: co»o~nu.s co..~~.~ur...o ~o o~.r.. ~~i »o~ u...eo ~o c.~u c.~.~~ ~ w~ '~:~1 a.y~~ s~w.to oert~~...:wo u~s~ /l ~ o~ e~.~~ It~ ~ IM i?..EobF I ~CC~DENT, S~NC~Of b~ OA E W3 r ~.w~rw. w~, .e.~ ~ MGU4 1 MOW INlUR~ OGCU~lEO ~~w.e~ ..•ivn W~wiun ~w r.~~ ~ w nn .n~ ~ NOMK~~: Ot 1M~[IFfY~N[~ ~ ~ . ~ ~ .ti~ ~ I ~ N ' ri ~ IN/U~~ ~i wO~K ?UCE Oi wHI~Y ..o+~. ••w. ?r.en, ..crw•. tOCwT~On ~ arun o. ~.~.e ..o.. c.n o~ ~o.w. sr.r~ ~ 1 l~~C~n t~ f O~ ~+OI pNK! MDG .~K 1 SnC~ 1 1h ~ ~ ~ CE~tYKwilO?~- .w~w w• I •.o..n. o.. •i.. .••o a~•• ~~•/~ee .u+e o.. ~ aolo~o .~oi .r.~ r..~ ol~~M oCtvuto e..~ r..c~. s~ .w ~ ..O~~r«p D.~ r~u ~OOr r~e~ D1~~w ~wou~~ D~R. ~MD. ~O M/ M)~ ' ~M*S~C~.rt: TO t 0-4-74 ~ o~ .r a..ow.~xt. oue ~ ~»o.o 11-15 63 8-4-74 n~ 1~,. .1~~3r /~M .o <.,,u,., s..~~o tl• OlCl~flO ~~Or CE~TRKATiON-MEDKAL FXwMWER Ot COtO~+ER. o.. ~•s~~ a.K ..ow o• w•~+ r.~ oeuw~. ~•f r~w~a~~c~o w o ' W~.Wh. ' ~ MO~aM Wt ~l~• wOY~ ~~~rM~npr~ O~ nM ~00~ ~~+0lO~ fW M111~Ki~i~. ~r~ ~ ~ Ot~M QCCWtlO ON Mt D~A ~~D 011~ q M 4u1l~~: ft~t10 , II~ ~T µ ' t2~ ~ - -~DATE ~ EO ~ r r~, o.~, n.~ ~ I CERLf a nn ~•~,••n 1 SiC~~tueE oecne a nne . ~~~7 9 n. ,ru ~ . _ _ ~ ~in~. ~vleyer. M. D. ~ ~ ~,.KN+c.oo~ss_ ' pierce, ~la. 33450`~~ 7th St. ~URiAI. ClEMATION. REh~OVAI 'CEMETFiY 011 CiEMI~704Y-NwMF IlOGT1pH t.~ O. a•+~ s~•n - ~ ~ Ft. pi.exoe Flori.da ; H~,].ls~'~st ~_Card ~ OATE '~~M, a~• fUNERAI MOME-~~4,v" ahJ ADDRESi ~ vaei O~ ~.r D O, Un O~ ~O~+w, s~~r~i~~ Florida 33450 ' 8 1974 RD H(~,901 N. 7th St., Ft. . . i 7 _ OATf ~FCF~~EO ~T l~C~t ~j~ftj,(~ R [ Y. S. ~61Y f ftA UR ~EG`S(tAR./ 'S1GN~TUff - Q • 7M J" "v~ ~N tW Au~.,T. ZS ~ 1J /4 I QlV. 191~ t e t~rs~eoord o file~n~tFw StalucierCounryPH~elth D~oert- i1LE~ R!~`,nUMTY fLA- ; st.~~~~~-~-:,,1~~5 ~ 3a~3~ 1Mnt et Fort Pivrce. Florida. i~~~' ~~ti COURt aM~ Not va~id unless ra~sed ~ea~ of ths St. luci~ CIE~K ~t~: ~rp (W "9~ ntr.oi r,ri , , : . ; County Heaith Department is affized.) . ` j'~~.; . i O~ y~ ; F o~,y, ~ ti,. - N. D. M I I I E R, n n. o. MA~ L . ~~r r . • Covmy Ht.aith Offitar 6 trocei Rvsistrer ~ ~ ~ - C. ~ G ~ - _ - _ - ; " - ? % , -:'+c p~,~ L,otel R~o~stror _ : ~j ; . ~ ^~-,1110~.~~ ~ £ ~ ~ 5 ; ri S y,:'i ~h