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HomeMy WebLinkAbout1443 ' CERTIFICATE OF DEATH ~ / ` ok,..~.e.~ d (le.al~ ..a ReL.61tN.H.. se..lc.. F L O A t D A RATt ~~~e No. _ ~MViax. r+rw~.n~ ~ fYIE, O~ MINI IN ~ R[GI~TAAR~• NO~ N~MAtNN? INII DECEASEO-NAMI ~ naU ~ SfX OATE O~ OEAM ~~Owlw, ~~t. t~u ~ t k[ fuM~001 fOt ~ t wsiwcnas ~ ~ Male ~ ~eb 11 Z S RACE .~n~. wwo. u~~Kw wM~w, AGE-uN w.~e~ ~ ru~ w~a~ ~ w? DATE Of NfTl1 ~.~o~wM. ws. COVr~iY OF DEwTN t ~a ~sncr~~~i~ uaww~~~e.~si .wa o..i wwn ..M. ~ _ p ~ ~ 85 » w ~ Indi.an River = CRY. fOYVN. Ot IOCAl10N DEAiH ~s~s! cwt ~w~ri MOSMAI Ot O:HE! NS UTIOM-N ~Y rpt ~w fl~wt~. Gn1 S/y1~ ~NO .rre~ ~ ~ snaa .~s o..w Vero BeaCh Yes Indi.an River Memori~ a.. . SiATE Of N!M ~ Y w0~ W Y 1~, Nu.a dT12EN Oi MR1AT COlMtR1f MAlRIEO, ?~VER MARbEO, SURVIVl/G SKK)SE ~ae. G~ r~~etr ~urt ~ t i WIDp D. O~ wtn ~ p~„~»~. • Washi~Jt,on. 1).~: USA Marie -Fbster .~.ee~ oeu~ses SOCULL SECURIT~I NU++VE~ ~ USUAI OCCU~Ai~ON ~wn aw~o w.rou ooru owoa ..os~ a ~o ~ oa~a~ ~ KND Of MlSM~ESS OR INDIlSTR~ occuaeo w " S I 7~01-5114 . u•~$.a.a~.C41t ~~er ~~p~2~,~.~ t~ /~,~~~.y ry~ ~..vdu~~W. GM ~ ~ 1~ ~~•"~J~il ~ O 114a1.. W• .e~.c,~..ce aroM . •c"'~"~'+ tES10fNCE-St4/E COUNT7 Clf~, TOWN. OR IOCAl10N ~LN c~n irns SiREEi AND NUM~ER~ ~MK~~r ~It a ro, ~MFlorida ,p St.Lucie Ft. Pierce No ~w 6706 Ft. Pieroe Blvd. fwfnFR-r~~E r~n~ woa~. ~•s~ MOiHER-AUIIDEN N~ME ~us~ .upae uti~ „ Jadnes S. Goldsni.th Catherine Aldr' e 1?1fORM~NT-NAMf MIIKING ADC~fE55 ~fnen w~ r o .a . t~n o~ w.M, sr~n, :r~ Marie Gol,dsmith 6706 Ft. Pieroe Blvd. , Ft. Pierce, Florida 33450 tAR~ 1 p[A1N WAS UUSEO /r: ~ENfIR ON1Y O~~ CAUSF /fR lWE FOR (o~ (b). ANO (c)J ~ ~w u NIrlW ONY~ ~MO N~IM r t 1~ - r~fO+wR C~YS! . , . . _ - _ ~ ` s , ~ Y~"`1 • w M . ' ' y. , COM~OIOM3. wM, I t\ ~ ~~J (~,J•. ~ 1 1 111MICM 6~r! ~11~ W ISIt: 3_~ V'~rt~( ~~-.v c. ~ Sy ~rnfO~~t~ C~Yf! WI. OV! t0. M~1 ~ tON310V~~K! W: ' ~l~tlw0 IM~ YM~~~- 1 r . . . ltlw0 C~Vf! l~f~ ' ; ~ r.-I~_~/ 1 ~ . 1. ~1.- ~~L,.,~~j - ~t, v ~c.~~ ~ y~,tic . a~ ~ ; ~ ~A~t e OtMEt S~~fKIJ~1T CONDIt1pN5: co~wn.e.~s cwn ~m.q p w•m w~ ,p~ ~eu~ee o cwu omw w?~n ~ wi ~~Y ~ ~ES r~~~ ~~M~INO~ ~OM• _ I ~ IR~ p MOI MN\!O ~M OftfWM~MO C~rM . 1~~ ` I-~~ ~ / ` • ' ~J , l~ ~ ~n.~.'i ~.i ~~~I_Hr~. OIYf~~M 1~! c • e . 1 ~ _ ft ; ,t !~.^1 ` - Ih ~w MDM~CIDE. OR tMAEtEWWEO A ~~~iw. p?~, qul . HQW INNIRY OCCU~Rf~ ~ t~nu ~uhNt Or ~wrin ~w ~~n ~ O~ ~ut u. ntr ~ ~hrl ' . IA 7h 7N i?+IIM~ A/ WORR KACE Of NAIRY nort. r~~r, ~nen, ~~on. lOCwi~Otr ~ snen w ~.r.e. .w., nn w~o~.n, s~•w ~ ( f ~ s~ecin r! f w+O~ aNK! MOG . tK ~ SNCMr 1 , . ~ ~ 7ti 7M ~ ~ f CERfMKAilO1d- rO~~tr O~~ ri~~ rp+w~ W~ ~l~~ ~+~0 4St S~r rr/~ ~?rv~ p~ yO~p~O~O MO~ v~t~r tW OEA1N OCCURttO ~?w,~. p.. wy f F . •N~~K~AN~. ~ TO / I rOM/M O~T RY M~f ~~iH Ol~M ~MOV~1 ~ ~ O~n. ~MO. q M/ M1t i ~ 74 oece.uo nor tt~ ~ tl~ ~i ~ !1~ ~11~ ~ M u .we c. ~n~.~.o : : ! CfRTYICwf1pN--MEDICAt EXAIrWdfR OR C ER: on n.t ~~s~s d~r »py~ p~ qaM ~w~ oeceo~M~ r•f •w,.p~.,cw w•o E ~l~laM~11M~ W IIN ~00\ ~I~O/O~ h11 WVtStK'NIIOM. IM Yf QIMIQ~~. YQNIM p~• •1~~ wOY~ ~ Ot~M (ICCY~ffO OM MI WM ~IW ON 10 (IN U111t1t1 SI~ilD _ ~t~ r. m ; ~ Cf~?IHE~- HAMf mn o~ n~«n ATURE % 1-wen ~nur-- -~DATE SI(;NED~+vnr. o.. .e~?. ~ ~ - a ~ )H lD _ . . . ~a ~ ~ ~NING A00lESS-CERiM[R srne~ o~ ~ r s a o~ se.n -j--- ' tlM1Al. CREMATIpN. ~fMpVAI CFA~EiER11 OR CREMA:ORY-NAAtf IOCATION t~n o~ w.... y~.~e ~ ,..~"•.Burial (Removal) Hillcrest Memori.al Gdns. Ft Pi~ ~ - - - - _ - - - --Flori~da - OATE ra..w, w•, ,eu ~ , fUNERA! MOME - NM~tE AND ADWESS ~ s~~~e~ o~ ~ ~ o. wo., at~ O~ torw, sr~tt, i~r ~ ~ Feb. l.1-, 1975 BA~RD ~I, ~~Q+~ 901 N. 7th St. . Pieroe Floaci.da 33450 ~ ~a l/ ~UP1 ~01~ECT0~- y/~,,~,~Af{NE REGI I! R-SIGlfAfURE ~ OwfE ~tCfwlD tOCw1 ~tG~SIU~ { Nev.:4~i1 1S~/ ~ ~i. [ /l ~L. `C i/ ~ S~ ~i /Ci~j. tA ~ ~ 7 ~ . . . . ._...~_.~,..w_,...~....~.. _ . ~ ~ ~ '•Z he=eby cert~ty the ~bove to be r trve nnd correct copy ot tfie 2oc~7. registrax•s zecozd on f~~e ~n the Znd~~+n River ~ ~ ~ County He~~th Depax*r~ent T~ Vexo Beach, r7,ozida:•' ~ nmA~ ~ ~ x c3 C ~ ~his .~s -not vAl~d unZ~ss the za~sed sea~ ot the Znd~an , d"' . o ~ c>o ~ R~ver"_;~o ,He.a~th Dep~rt~ent is af~~xed. c'^~°~'° p ~ ~=I~ ~Ql1t~~1~~ ;a` a os~~ ~ f,•,L • ' . _ ~ v, ~o ` ~ - . ~ E - ~ ren : ~ ' ' _,+I t . i ~ ~ sp ; iY` ~ ~J~•~ ~ ~ ~ A ~ :z, ; • ~ County Iiealth Dir. , I-ocal .Reg. 'r 1 / t `C.. ~ ~ ~ ' _ ! ~ • ~ ~ ~ ! r . , ` ~ ; C ~ Q , ~~'rI „ . • ,~,.:;F. _ :s:.~ ~ ,~..t - < ~ n~..,.. R r~ i~ st rT X ~ . ° R PACE1442 ~ BOOK z ~ . - ~ ~ ~ i • y~.~ - ~ I - ~ _ •