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HomeMy WebLinkAbout1086 CFR7IFICATC OF taEATH • ncpa~lu~ent o~ ~~cw~th and k~~~ai.:~i ~r.icrs STATE FIIE KO. iu~r~u: u~ ~n .i ~:i F L O R I v A ~ 7, i t O? ?~1NI IN ~awv~+~nu n~:.~+o R£GI$TRAR'S NO ~ rca~.;s.ruHt ~NK .,~:w;e SEi UwtE OF UE~I~~ c••, S'E M~~~QGO~ FOl ~iCUSED-r~w~uc nn~ ( ~4s,~~;~a~s , . NESBIT B. SILLSLJR.:.•lale I~ October 3~ 1~73 RACC rM11I. M~G~O. ~~I~K~N INOI~M~ AGf -~~5~ ~•!~~_T~-:u ~ O~~_--r~Ait (1f !'CTH ~~0~•+. 0~~. iCOU`~iY Qf GEATM _ ue. ~ s.~o~. ~ u.~~o.. ~.e..s~ ..os w.s j ~ou.~si r~.~ ~ . ~~Thite 42 ~ L I~~ I-- . Au . 28 ,19 ~1 Bro~vard ^ j--- CIIY, 10'~~N, Ot IGCAl10N OF DEAIH u0! C~rr ~.rna ~ i~OSPtTAI OR OAIiR NSSI:UTiON-NUnE r.o~ u~~~~, G~+t arq~t ~w~ e~o..~l~ • uiur. n~ o~ .+o r Fort Lauderdale ~res Holv Cross Hospital _----.:--t--_--- - - *S_,e S „ ~ - - j+ - SIA~! Of 6tRIN ~u «o~ ~ s~.. ~a~~l,Uii[CN lX ~wM~ tvu'.i:.. l.~i~:E~. NL'.'EC ~+~t:.:.:D. ~-.Vlv!r~[. PL-J5. ~~~~e, ~r~. .,~b~N w..i~ toorm~~ WIDOWfD.O;'+OKED~v~can f .5_.~ . No?-th Carolina' U. S. A. Married Anne Lc' nc~ ..:~e rt:t.uo - - -~---_.j ~ KIrtO Of 6:1SINESS OR INOUSi~Y ~~~t~ ~(~~ul SECJ~I~Y ?:Uµ6fR USISRI CJCCIiFAT'',Jr~ ~e~+~ a~..~ o~ +~c.. oo«e o~e~.w rosf or c ~.~o rouw~ ~ne. t.e.. ~inuo ~ ~~`~~~°~~°^~f 261-44-84c5 ~kGeneral Ins._ r~anauer C. B. Arbo ast Ins. A enc • ~ - - - ~ - - g--- = ••~~s~~~~. RES~~Er:Cf-Si~li TCUUNII' GiT, iOn'r~.04 tC~:~1~0~+ ~~~~~oe ur* ~~..++s~51FEEi AND NU~~~fR ~ 111ICIt~ 11f O~ M71 ,~=i'lorida Martin ~,.t7ensen Beacn no ~,~,Mandalav Drive fAl!~EK-NA~nE n~s~ .uoae i•s~ IMGitiiCC--wu~DEr~ nfu.~E ..~co:t Ns~ Nesbit ~ B. Sills,Sr. Mabel - Ascher ~s INYJ'+A.V~~:-HAMf ~K~VG ~DLRESS ~s~~eet o~ e r.n ..o. c~r. oa ~o~~, a..~e. :o~ Fla . 3 34 57 Mrs. Anne Sills ,h tiandalay Dr. ,Sec~a~ 1's Pt. ,Jensen Be~c:., ?wRf L OfwiH ww5 UUSEO 9~- (FMER O~ttY OriE UuSE vf~ t~vE ?CR ;o). ~o), ar.p ur`+e!~ o+srr oe.:+ . w„eo~~n uu~t ' . , : ~1 ri~-~% ~ ~oS~~; ~ 'J~~-~ ~ `J~ s "rl~,~i ~ ;a ~Ivu?: 0 ; ~iitTa-w co..s,o.-....n oi .i~~p ~ ( n/ ( ~ COMOI71ON3. •M. n v+wKh ..v~ ~,s~ ro J (b~ '~-V ~~"1R'lL l~~\= ~ I,~ J~~"S~ . I~rlGI~11 C~VSI {~f~, I p~! IO. O~ ~3 ~ CO~f!li~l~.:f O~ ~ ~ S~w11MG ir~! VrDl~- ( ~~1NG ~~USt l~S~ I i/ t~, ~ \ ~ - f ?wR? p. UiME¢ S~:,N~~KU1T CJt~~iJiO:+S eo.+o.i~a+s eo.~rwun..o *o oe•r~ wf tio~ ~eu•tD t0 C~~1F G~+Fw u. ~ur ~~m AU1WSr IF YES ~ne n..o~~cs ex-. / . ' ~,n a oi oi o .rN.. ce:e~.. _..>e: s - ~kY~S t•, ~jcS ` Np ~1 ~ 3 p~..t..~~~~t fC'~•'•E~tT, ~!Yi7i OC OAI~ f INJU~V ~ rc~tn. w~, ~t.r~ Fb~I:R HOW INIURY O:CUiRED ~ i~tt~ .uiv~t O~ IN)G~I r•~• i or r.r n, n~.. ~ i K~!I'C'.' E; 02 Ut~Gf1EkM~titD ~ i 7k M ME • Yo~ ~ . f ~ltpJTY wt wu?r. PU.Cf O! ~~:n~RY «a~e. s:~etr, r•vw•, ~~~pTIGN e snta e~ ~.r.o. .+o., a~. o~ ro..., sun ~ ~ ~srtarr .[a oc wo~ pflKt llD4..tK ~srtu~.~ _ 7Qe 7a 7~ ~ ~Et:IFICATIOr~- ..o~+rw w~ ~e.e ..o.+rn o~. .i.e .~o uir s.« ~~..i,.c~ .i~.e on o~e/a.c •rr ..i.r r..F o:~i.+ O!eucrt~ r..e..._t. e- '`e /M71~C~wN: 2 rOwrw C~~ rE~r tGDr ~rit~ [t~~w. ~wo~~~ ~ 4r,t. •D ~e ~S" tp . 1 ~R[pOtD 1wf ~C~ / IlJ ~ ~ TD n ~ f . _ S~ IS O~ r~ ~•.7`.:!}.i tL e[c..see no.. -1 '~t! ~ I~ ~71i '~L~~ 11! Il ~ tie w ro u_;c s. s-.-t~ ~ - - ~ CE~7IGKATION-MEDiCAI EXAM.WEP OR COCONED. oK uvs o~ r~t wo~~~ o~ c.t.rti ~~~e o~ctu~.+ ?.s .~ovy~..cee oe.o ~ lll.~ N~TrY~ O/ ir~s lJD~ ar.{..'(t~ T?! ehrlS"i~'lt7~a, .A r1 O~Iti~,w, Y~O~!~'M D~\ r ^ ~l~t M7J~r~ 5 ~ ~ ~ • G.~M (;CCU~~lu (r~ !+t G~r1 ~n0 Dclt t0 C~Nit~Sf ]~~•ID. M.I~71 v ~ ` ' • 3 v _ ~ Y P-" ~ _ ~ ?1i - . ~ 3..__'_ 4 CE`11F fP-t+w~•E sn.e c..:.•.'~ S:G~tAIUR •e~[e o~ .m~ -j~~TE StGtiiU ..e.~ ~ f~~i~. ~ . _ ~~2,~ ; ~~c~~ S~_ _ ~_~1 ~rk c~~ ~~i 13 ~ r f. } s»eU oe ~ r o ..o. ~n /~y snr[ ry' Dr j ~I:M~ ~ ~fSS-~~':itt~ ~'{/Ill~l ~ \ c rv-n-nZC ~~'R. t_ui !_~ts ~x- ft ~ i~~ ~A Zl3 d 3 CURItiI. C?:fMnT~Or~. [tvUv~i ~Cf~nftERti O~ ~~:r..~7::Rr-rv~vd ~OC~t~Ot~ c•rr o~ f~«.. ~,.iE i I ~ _ ~~Removal,Burial Fernhill Cemetery___~~~, Stuart Florjda l 3 ~-~I' ~~~'r(~~"- OA/E .o•.~•, o.•, .ue~ ~fUN[D,AI NO'~E--NAV~ A!/~• L::'?~fSS ~ snen o~ r. e+u-, cu• o~ ro~~, s-.re, n?~ ~ ~N Oct.6,_1~73 ~1 cocY. Fiinera? Y.or~e1505 So.Fed.~-a~•~v. ,Stuart,Fla.3349% 't J~![ ~t:E~'.E'v N lG~~t .~5'~~: ~ . ~ r.S.l~1? /I.NEiAIL~Ri,Ct10D-S.G~tAIURE r P:G`7t4~::->'(::i~.:~~. } i _ F e v. 1910 7S! . I/ i r' /i '~'f fi Tka 7r.;"~ `~t -~aS ;:,~~~~..''Y, ~ 7eS l; ~ .T- ! ~ ~ i - - R ~ , ~ ,q t - L. i ` - C"RTIFZ'-:D COPY t~p3~44 ; ,<•s,l l, - ,r~ 4 - I h~reby csr,ti~y t'~i? ab~ve to be a trus and correct copy of the Local Regist: a~~' ~'r ;cffi•ci fi7.p in the Bro:+ard Countf ~:ealth Department at , , ~ Fort Lau~ar::a~~, ar.`l~arSda. - " t- - _ ~ r~r> • E~O~C ~ ~ ' (:~ar:.iza: • iio~ val~~d un:~S,;s xaised seal of the 3ro~+ard County Health N~~~ Q~ . ~ ; ~:vspar'~~c~i't lf~'s ,afiixed. ) o - . ~ _ _ ~ -r~-~~ ~ . ~ h , ~ ~ ° ~ ~ Cour:ty ::sal ~h Of ficer' and Local i:e~ist: a~ ~ ~ ~u 4-23-7~+ . - ~ . ~T//_ -vs i .1'~t_ ~~i ~E La~tiLy I.oca7~' ~tegzstrar :5 . ~ ~ . = ~ ~ ~ ~ eoox 237 ~A~~ 1085 ~ ' ~ ..c.~- ~ _ ~ Y, --~,?4:9`~...,.c~ _a7_ . _ _ - - ~_..._r