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CER'Y'IFtGATE OF DEATH ~
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ava~on~~w~ F L O R I D A R~a,n~~~•s No. 416
TY?t. 04 ?~M IN
N~I~AlNN1 INK ~_NMrE ~ ~+w u~~ SEX OATt OEA1N ~•o«*~. w~, ~a.~~
B da Male z Au ust 15 1974
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~ ~ Se t.18 1906 St. Lucie
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66G2 '
Yes Fort Pier e Memorial Hos ital
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. "~DO~""°'~~~~`~~ Vir inia Thom son
~~p•~ Pennsvlvani U.S.A. N Married •
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~ ~r ~q_ 14. PO t St. Lucie ~N. Yes ~a. 3118 Ov~ez'brook Drive
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n R. da e(NNN) Wallaoe
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ir inia Le da 3118 Overbrook Dr• .Port St.Iucie,Fla. 33452
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I WMAt. GlEW?i~OM. ~f/MOrAI Et1r OR C~f'tATORY-HAME tOGT10N un w w.w sun
Beaver County, Penna.
,w g~rnral-gurial Locust Grove
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~ Ropittrers reoord on f+le t~w St• lu~ie C~^tY Health ~ert-
~ rr~?t ~t Fort Pit?te. Florida.
(yyatniny: Not vslid unless ra~se+i seal of th~ St. Luci~
County Heslth Oepa~tment is affixed.) . ~ ; : ~ ~ .
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