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HomeMy WebLinkAbout1192 . ~ ~ 14'7985 ~ ~ . 30~;~i2.~ CERTIFICATfi OF DEATH ~ =t- ~ ' % ^ - ~`O~'~;'' _ =r' ~ ~ J ~ D.p..~.~..~ .t ~ k.t~ ~ R~a.TMtn.ew. 5...~. F L O R Z D A *rwM Mt~t xo. ~v?!, OR ~R1Nt ~N ~~~~~YR~TM~ RC6~6TRAR•s NO. . ^^..'!fl~!.•SM INK SEt DArE O' ~EATM ~•o~••, o.., .u• ~ DKEwSED-NAME n~st ..ww ~ws• s=.~ :~:xc ro~ ^s~'~~«`n , . BRli CE C. QYAI,L b:a].e i~ ay 28 , 197 3 RACC ~n~ M~OW. ~~~~CAM ~wouw, ~ AGT [-t~fr ~ v~.~l~ ~~1~~ wof~ r v~s ~ D~TE Of 6iRI„ e~M. M~. COI.^1Tr O! DFATN nc r srecw~ ~ w}'21tC ~ r..»~A~y.e~~ss ..o~. ~ o..s ; »o~~s ; . . .eu ~ ~ p(+ „ ~ , ~ ;r~:ay 5. 188~ Ir.dian River Cour.ty _ ~ f~ C~TV, ~Owv, OR IOUT~ON Of OE~M ~.sro~ u•. ~w~•~ ~ rOS?Itwt 0? O!NE~ 'NSTITU7:ON-N nr ~o~ e~r..n, ave s~~en ...e .~..~e. . a sna•. ~s o• »o • ' ~ Vero Beach :~o I,. :~ecca Convalescent Home .'T.~-_':" - S•w~t Qr 6+Rtt~ ~ N.o~ ~.s K,•i dnZE^i O` wra• CO~.'~rer ~~??~~ED. ~Ev~q w.~c~~[D. ~SIJWrvmK, SroUSE ~ n vu~. awe ..roe. ww ~ cow.n.~ ,w~DOr+FO.OrvORCEO~ uw•~ i 1eor~ia U S A +~:arriec~ Annette GA~'OE Ryal? ••-~•r o~a+s~o SOC~At SECVR~tY t~V~nS:R , r.•» 'JSUAL OCCL'•wT'Ov ~u.~ a.,e o~ w~a oo..e ow~»c ros. or 'KnaD OF DVSRtESS OR n~OVSiRv .~~.•eo weawc ~.~e. ere~ ee•~~n r 263-12-$931 I~,.. ~rove ~wner Citrus -'~c! ~~•c.e 1 . i RES'DENCE-S1~t1E ~COVNr`I i!~'~, tOWN, Ol tOCAT:pN ~ w~ C~ ~rns S1R(ET A.VO NUM~E , ~ ~ ~ s•eu•. .e~ a ~+o ~ ~L,.. ~iorida ;,„India~River,., Yera Be~.ch Yes 1~..1844-22nd. Ave~ue ~ ~ATH;i-NAM: r~y~ r~yKt uf~ ~ MOTM[x-AMlOfN HAMj ~Nff r~DD:! ~wi' i~-w.wrr ~ „ Charles V~estley ~yall ;~;ary Alderr.!a-~ IMfQoWA~iT-NAMf ;Mwr_n1G AOOEESS ~sr~ei. o~ ¦.~.e. .a., em o~ •o~~, s..•~, anr ~ „ ~~?.t. nn_~ v -T-- ~i -~nCLf+ i~ Z`S. ~nnet~e jS~id11 ~.n 10'~-`r~GGI:Ct. ~iV~T1LtC ~ rt"sL ~i t~C~L}~t L'~G. c. _v.: ~ °~Ri t DfwM WwS UUSfD ~1': !E'vtE~ Orr.~ ONf CAUSE IE~ LN~f iOR (e~ Ib~ AND (tJ; j~t~rrer o~se• ..e r~.-r i . .~.eo~.n e.e.e,.~ - _ ^ . - ~ ~ ~ . ' ~ / l ~ r ? ~ ? ~ l i _/-'..f~i_ l./-.'I'r!~L~• . ~1 /`i- ~ =~^,?-i / t_,.. ~%-l~"l~ c~1`-n-- ; / ~ ' . i ; w ? wllOu j cor.~rw~• n..n, ~Y_:: i_? r' ~ 4~. ; ~.~cw e..( ~~~e ro I tAI / ~ / ~ _ - - i w? . ~ ~ ~ ~rr~D.w~f C~ViI ~e~, ~ e„e ~o o~ •s • eo~sro~n..lo~_ ~ 1 sunwo rre ureu. i .f ~ ~ ~.~~o c.vsr ui. ~ ' ~ _ • - (c! € ?Atf h OTMfR S~GN~KAVT CO~+WTIOHS~ ~~aryas ~~'nM1yli.~p q p(~n~ ~y~ wp~ ~[U~~O •o u~s[ o~.er w. r•n AVfOrS~ ~ R ~ES rr.e .•..e~rof ec~- (~t~y p rp• ~ s.eHH ~w Dt.e•+~~+~ti, e•!T , M Ot~rr '1ti ~ Q i IA ` ~?ro~~h1 ACG9ENt ~ w .N ~ ~..o~•., n,.,.a~~ ~H ~NOw I~+/Utv OCCURRED ~ ~••~n wro~e o• ~~r~n ~w , e.•... •e • . R . ti0+~'POEr O! V"f~Lt[IWUHED ~~.y} l s :..o ~M ~~k- M ~Md ~ 1'~p~ev wt wOK i'tnCE Of e~1VR~ .ow. n~., r«.., ..v~•. :OC~nO~ . s•.ee. w~.r.o. ..o.. em o~ •o..., sr..i ~ p ' ~ ~.~~i~~ ~If O~ .~0~ ~MK! kD6.lK. ~SHC~n~ ~ t 12!' • r! r ~r~•~rfCAtiON- r7.•w w. •t•~ ' rp+~s. o~. ~•h Ms• s.. .v./M~~ .irvf O+ ~ Oo/o~eK~+ ~•fwr m!~ DCAIM ~CVtr[~ w.e ru!r, o.. [ I•M~sIC~.H: ! TO - , r0`~~w Oi~ ~t~~ ~~001~/ff~Of~!M. ~~OV~1 D~~f•~v-.'~+.I..~~ " ^Ir010 Mf q t F O~ ~ •+~0`+:~Y.• 7~f ; 7•• o~ce.sior.or //J.i ;l~f ~-.G'!J . : ~2~~ f • ' % {SII , ii~•~:~~~ o.,,~, ,.s,. ~ ~ C:QT:"../~:~0!+-.r~QJKAI Elc/Wir~ER OR COROv~R, o+~ r... .,s~~ o• ..a~. o• e•,~. ~•^e o~etee+~ .ws ~~w.o~•.tn ~t•e z e,..»...:o,,, o. wo. ..olo~ ~we ...es.c..o~+. w o.~.o-~. .o.•. o•• .t.~ .o~~ ~ . cc_,..ro a. +.e wn ~rD Ou! W... ooi.~s~ r.•eo ' '~:rn M ~ :~p. s,se_!v.tME ~•.•e oe 'w'UPE ee~n a •~ne ~ E 'GvfD ~••o.•.. o.. i 'lernor. L. Fro~an~ ~r=%r!'i'~~r %!.~+'.D. :k~:a~?_S ~ ~ y~[!' O~ D w0. C•'~' W'O~Y+ _ f•~•e + 1 NAr,vGA7J7ESS-CE~•:~~:R pC.~nn n,n~:yn~ ~'1 ~"l`i^o VPT'A '~C??r}~y " ~1?+i ~n : f.~~ ~ . 3~'~~t. CRE/+.A'~t+, Rfw!Ov~l ~CU+:'EZV U: rp=•,u~'Onr-i+tv; tOC.~;:OH e•*• oe •o.+..~ t:. >..e, g - ~ :iLIT'121 ~ tu v?'eSl? ~^.'tl;'? ~ie^:eterv ~t'~ V@`_'O ~e~~h. O:"-C'.(' : a'E -.,-o-.•r o.• a~u i! ^~fRAL MOM(-NANC ~r.7 ADDaE11 ~ s•.rer o~ o. o., er• O~ w•~, sr~.[, t~r ~ e 1 r.~ ""~?/!N~ ~~.1 :s..~.QX-~~rrO."~ ~?;~1-~11--~.?~~-1i~C zQ,/+~'r`~.St..Vero'eac~..~~~~~2.~'C'n j V. S. ~512 i D:. /-,y J ~~7 ~ ~ S:::r~wiU~~3 /1/ L wie [eCe. -i te , ~ _~70 • ~ j,-%ii~~~..J;~.G~J?~'' L i c . _ 55 :i% ~'r~f--J ~ _ /~A/`,l7~~t?~ rJ'" %l~~l ~J "I hereby certify ~he ~bove to be a true ~nd correct copy - ot the locTl. registrar•s recoxd on fi~.e ~n t:~e Znd:;.~n ;?ver ; County He~l.th Depart~ent Tt Vezo ~e~ch, F7.ozzda." _ . ` This ~s not valid un~ess the raised se~~ ot the Xnd~an , _ Ri.vez County. Hea~th Depazt~ent is aff~xed. ~ ~ 4,,•; i:t + . - ~ ' . ~ - ~v . ° - ~ " • • _ Co~~nty •.iellth Dix. ~ Local Reg. ~ ~ ~ 1 ~ , r • : : 'j ,t`. ~ , / p;~ C /"1n / /Q~ wA n I~ ' • _ , I/~v '.1~ ~ /[/~i~/r l, ~'l D n-~n.. ~ 'Tr~/1~.$tXT r ` ~ ~~2~1' go~ 4 3 Fa~F ~33 ~ QFFICIAL RECORD _ _ - _ . ~