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HomeMy WebLinkAbout1282 a~(~~6~8 CERTIFICATE OF DEATH Ir~r~t~~~..~~ Il...~;i. ..~.s h.~:.i.~.~~..~~.~ ~nur. 9TATE i1lE NO - FLORIDA '~•1U•~~i:~ ~ . . • ` • • pEG16TR~R S NO - ti~ ~.T iNt . •r .SEt 'O~lt O~ Ol~iH . o.., .r.~ . ..iCF~1fJ - , ~ " ' • . . ~.:1 i~i 1 ~ ~ ,j~ ~ remale ~ ,tpri. 5, iy~t• . . . ~ L~?~"~.: d~. ` ~ . _ _ c~ / ~ ~ ; .•:i • . •.c . . •Gi -..v .o•.:r. ~ a.. • O~IE O~ ~M1H ~.o... o... COU~aIV O~ DEA1N - ' . ~ z- - . . ~ . ..=~e o~. ~ :ar. 6. ,-y - ~ i' '190b t3re~rard • i.cr ipwr~ ~ c.CiC•t~G•. Gr~ p«t„ ~..iw~ c,.. .,.~~s ~ NOS?ITAI O~ O~NE~ WS111U1~ON-N~.NF w. .r a~.r v.~i~ ...o ..u..n~ ~ ~ - / ~ , s.~;.~. .~ti c• «o ~ , ~ ' ~ :'e~::c~:r.e ~'es 3revard Hospita2 _ ~ - - ;1.'f G~ i ~c~• • ~ ~ G'~Ifl~ rf Wr~Ai COJNi~`/ ~en~ca:EO. ~+EvE4 Mw~UEO. ,SUtvrva+G SPOUi4 e~.r ~ - - - • . cw..•.• , w~ppwEO. OrvO~tCEO ~ sncr~ ~ . . ' . . er.r.s•. _ :~,r.:a ~ :;5:; `o ~.a: ried Aorahar~ De;~ir.k _ .s' - StC~- ~•~•,ai~ --~5~~: OCCUi~:~pr~ .c,.~ .,«o o~ •,o~. oo~.~ oua~.c ~o~~ o~ T~wO Or luSwESS Ot u~DUSt~r ' .o..~w, .~.r. .~~~.eo ~ i • : :ouse:ai_"e O~~r:~ ho~se - • _ . :'t,~:.E~.CE- S'~;c CUI.HfY -~~iTY, TO`KN.O~ IOC~LIQN ' '~f~of C~n ~.r~ry ~SI~fEi ANO HU~+~I~ ~~•~a.. .n o~ .a~~ i 'r ~ ; _ - , fUla::a2G0 ~ iCa~aT.aZ00 ' ~@S '~~083 Crest~rood S~`,: GC ~ '~:.•ii-r~~vf ' n~?r wOw1 i•v ~MOIHE~-~u~ENw~iuE rufr r~ow1 ~~f+ ..,i::ar•: ~ esser.der. Sarah Jolly . ~.rp~MwN~-a~ME ~a~NG ~D'uatSS ronu~ o~ s..o . u•. o~ •a•,», s•.~~. a•~ i,.:,ce C. ~e::ir.:c ~,,,~C83 Crestwood St., Kalamazoo, Micn., 49~" YAi' 1 •Ir~O~...~rl JE~TM w~1 C~~SEO ir jfNtf~ Or+iv O~+E UUSE ?Et twE ~OR (ol. (b1. (~!I ,~n+~~~ o~~~+ •«o o~_r¦ i 1~ ..:.~o:.-i~ ~.uu - - i .'1 ~ r . • ' ~1 ~('L! / i o, _ ~ - ; /1- - ~ ~ n~~ ~'~r: C ~C3~~ x i.: ~ f~.- , . ~ ~,-f~-- - s- bTfS.?.. .s . eo+seo~i~a o ~ 1 ~.i ~ t ~ , . ~ ;o. I r..ID~~I1 t~~t~ Dul ~O. O~ ~1 ~ C4ti11VN~~(f O~ • - - { ~ f'~t~w: ,..1 u.,0~~ . ~ - ..rs-~~ • ..G C•Yf~ 1.f~ 1 1 ~ _ ~ -r~UtO?S~ ~I rfS r•~o~..~., `t r..wi n Qir~[i StiratFw~NT CONp1T~0~~5 CO~O~npr) (G«r~quu.h, p DNtM ~UT »o~ .u,*eo ro c.ua •.~r ~~o~ F I s eo+ 'It11 O~ ~O~ j S•01~10 t.~ D~tl~r~r~rG C~Vlf S ' O~ OI~~M € ~Iti I 1~? ~ -r ,o •C~_ ~,-.<•.T • ii Ot DATE Oi ~'~IURY ...o w•, re.~ ~ r~04R MOW IN1U~Y OCCU~~EO ~ ~••q~ w•~w~ or iw~w• ~r r~n . p~ ~n.. , : ~ =•Y.•_ Jt. Gi l.'.JtlFC~r:r.EJ . ~ ..r~l ~ :a M tae ~ ~ i~ .~D~ AT V:'J4R i.ACf f.~f V..uR~ Y~In, ~Kror•, ~OC/~iION ~ frq~t O~ ~ r O wo.. Un O~ tOww, Sr~rl ~ ~ i ~ ~r~~... .~s o...o, 'pr.~a r.o:.~ec v~t,r., 3 j r _ ~8Q ~ . 2` !EL1.f~Cwr~ON - ..o..rw u.. n.. ..o-.r« o.. .e•• ..w uf. y.r ~~..lw~~ OH j~ ~~o/o~o ~.o~ r~~wr o.t~OUTH OCCU~~eo r.~ o•. rr~ ~ •h~yiti•v _O rO•.~w O.~ e~~• . ~~ry~ M~rw ~~rOU~r s./ o.f~ •w~ rC ev1 ~Ifr ~ ' , .•.~..o,o~ ~y ~/J... ~ • ~ / . _i • ~ ! . ~7 v 1y~ { ~ ~ : .3 ' o c.~i~~~xi. ow 1 r• c e:e.u ~:1~ M~'].af I~~ J~ M a: sr~,ro s . _ _ . _ } Ci:;~~t- ~;;0'._-,~rD~C.~ tA~Y.~vEp G= ~UiO~.Eo o~ ~.s~s w~»~ uov o. w.. r.,e mao~•.. •f •~dwv»teo oao , ~ :3 ~u.s~.~j ~u..... Oi r..r ~=.p. w n. e..e wv~s~..., . r. pr.a~ov. .Cw~r o.. r.~y• t; GI~i.. ~lC~~11:+ v. MI G~tl •wG Ju~ f0 ~Mf (~USI S~ S'~e\D ~ ~ S M~~7~ /~~a../• ~ ~ l' ` / ~ M ~ CEi11{.tit-_r~/.Y.t ~n~F !1~ r rf " _ _ . _ fGNAT _ - -Y"^'_.__"______ _ r . . S V4c ~ ~ oi~:.~e wl~.~ "OwiE SiGr~fD ~ c~ o. .~.u 73c ~ . i • 7i~ - . ^ . ~3 . ~ i /~v ~ y ~ . 7)~ : ` ~ ~ ~ - . . ` ~ ~ . M~~.~r.G ADU=iSS-:i•t.c.E~ , rnr o¦ ~ r o ..o <m~~ ~o.... 7 ~ yr.n t~. ; > ` i -n. .J J . ~ g,,.,w: Catwv.T.Or+, iEMOVw~ CFMftERY O~ CiEwu:~iay-r»Mf' i~OC~i~O?~ c~n o~ .o.... ~i i ~ ~ :~:'ra:~ova~-~~:'_a~ 7~? Kaia^:azoo, Nichigar._ `~1 . D~iF` .,«~r, o.., ~ ~ fUNERAI HOMf -NA41[ ar~D wpp;E55 ~ swn o~ a r s. ~o . or. o~ ~o~~, sr.i~. f~r ~ £ ~::-~-7~j ~s. ~revard-Souti~: P.O. Box 1 46 N:elbourne, Florida ~ ~ o„~i u«~~FO .~o~sT.,,. •;j2 f~.i~~~~,~D`aE ~C4 T "Y~' ~i REGl11R~ArS~GN~1U~Tf ( / / ~ / _ n_..:~/7c IS~\lY::. ~,:`..~e.., t)r..f 'ft"75 :e.. ~!~~s~~ 'C~C_~'~!C~-~'Tl`- ~S"-i1.`L~IN ( ~;s ~ :~'j `y I'r.~R~..~Y C:.R;~.`i THE ABOVE TO BE A TRUE r1i~D CORREGT COPY OF THE RECORD ON FILE I:3 THE LGCAI. RF,GIST~?R' S OFFICE I~I THE BREVARD COUNTY HEALTH DEPART,~4EENT. ( t~ot valid unless the seal of the Brevard County Health Department is affixed ) 'y " = ' .~U N ~ 0 t914 , " ; DaCe Jb4 Seal ~ , ~ ~ - f 1 Deputy Registrar ~ , ~ JKDED ~ ~ . ' r. ~ ' ti ; ; S{~lUClt COUNA~S~A. ~ ¢ f , ~ ~ : AGC ' ~t COURt • ~ , y , CtEy ~ ;1 f ' t.:. fis~Q?;s~ ! ~ ; : : 1F 0 , r ` ~ ~ ~ ~ Rfrn ` ~ pM'15 : - , - ~ - s.~- . ~ ~1 ~ sl ~ , ~ • ~ ~0~68~ ~ a ~237 ~12 ~ ~ _ - : - _ - . ~3~ _ _ , : ~.u_~