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HomeMy WebLinkAbout2424 CERTlFtCATE OF DEATH Dey.No~,~ d Ik.li6 ~nd Rel~abil~~aure S~..~. srwTS Rt~c No. t~.~wxr c~r ~uwi.rn F L O R I D A TYfE. OR ?tIHT IN ~~~~LL~`~~~ N[GISTRAR•f NO. I[RMAItIMT INK OECfASEO-NAME ~~~s~ r~~ t~ft ~X DAiE OF OfAiM ~row~M. o~~, ~~u~ S[F MJU~MO[ f0t. ~ Hazel T. Jellings t Female ~ May 7, 1979 RwCE wu~n. ~eGw. 1Y1\K~M IMOVM~ AGE-ut~ ~~ta~ v.w~~ ~ e~~ D~TE CV ~iR1M ~ra+rN. e~.. COt1Nir Of OE~?iM uc. ~ ancu. ~ uu~o.. ne,~i~ .os. w.i Moun ..r~. ~ui ~ ~ White . 64 k s. ~ t3ov. 17, 1909 Broward Cti1f. IOMM. OR IOCAilON Of OEAl1/ r+s~ee cm .r~n MOSMAI O! 0:1tER NS11TUilON-NAME ~N w~ ~M ~~~w~~, one s*~en •w wu~w~ ~ , wean ~ts o~ »o ~ t~ Fort Lauderdale yC'~ u North Beach b~edical Center ~ SiATE OF ~1RiM i n Mot w u.s M~re CITIIEN OF WIU1T CUUN1R1f wlARR1ED, NEVER MARRIfD, SURrIVNG SrOUSE ~M ~U~. c^R .u~'aw'MU'~ ~ cwe+n. • wiOOwEp DrvORC o~ vecr. ~ ~~:~.K. Pennsylvania • U.S.A. Widowe rret~t DKl~flY ~IAi SECUni11 NUM6ER USU~I OCCU?~IiON ~a•e awoa w~a oo~+e ou~~~c ~ws+ a Kw~ Of WSWESS OR 1?~O11S11tY ureD. U Ot~~ Vpt~wG UR. Mp Y~l~NtD 1 OCCUf!!O M ~..~~~~~~~a., o~. Re istered Nurse Nursing ~~~~o~~.c~ uwa ~t 118-O1-2~180 i~ 9 ?o..iiswM. lESIpENCE-SiATE COJNTY C1i1t. TOWN, OR IOCJ?TlON wswt cm ~rm~ST[EEi Mi0 NUM~ER ' ~ vea., •es o~ .a ,w Florida ,N groward ,k Wilton .ianors Yes 509 N. E. 27th Street fA[?~ER-nuwE ~~n~ r~oai u~s~ MOiMER-~uIDEN H~uv~ ~ut~ .uoae us* ,s George ~villiam Thomas Ma~n:ie Rodgers IN?ORM~Wt-NM~f M~lM1G ~DDRfSS ~sron o~ ~.r.n. ..o., un w io.n., sr•n. tr~ Mary Jane Coyle 286 Genesee Street, Lockport, New York ~r?ql~rw ~.t :u fARi 1. DEATM WAS UUSED ~Y: (ENTEt ON[Y ONE CAUSE ifR (dVE f0t (o~ (b~ ANO (c)j NM{~N ~MHi ~rC OU'r R w.eo.. e.ase ~ l 1 , i! 1 I+ ~ t' t~~ ( , L l .1~~ l1t('i~ , I! 1.~. ~ ~~~1' . !~a ~ r,1'~ j~~, ~ ' _ • M ! ! O ) ` ~ ' ~ ` l ~ ~ COMOIl1OMS, n ~wr. i~:."~.:~ ~ . ~ ~ ° . . ~,~1 vrw~cM o~rt ns~ to ! (p) ~.t _ ur~oute ta~se ~o~, I p~ to. w~s a ew.stowwte w: ~ . sun»a ~¦e v~o~n ` anwG tw~s! ~•Sr J ' - ~A2T.p OTHfR SK~N~KANt C 10?~5: eoMa~rpws eo.nn~un.w bi.*M aui uo~ awno ~o uua ~~+e~ ~N ru~ ~ a~ ~~Y !F YES ~+e~e fIMDING~ COM•: (~•~s o~ .n• oo~~eo ~M oe~e~r~~~..~ u~rset / ~ t ` o~ oe.~w ~`'`~•~'~"al.C. \ ~,1 ~\'l ~.`-j 11~-'~ .1.~ `'~Y ~-~"J~ t_~ NO ' ~.~p~p1~ 1 ~WpENi. SU~UDE Ot OA E WNJRT 1 rOM7M, p~t, tlA~ 1 rOUR bOW IN1U~1f OCCURRED ~~~+Tee .urvet p~M~un .ti ~ o~ ?.n w, rter ~ !~1S1)pM~ ~~M. OR (JNDt1EUA1NE0 ~ ~ '~Oe 70c M !01 i 1lWRY Ai WORK ~?IACE Of WrilR1/.~ wo.e. r.u., s~~ei~. rwc~o~,, IOCAt10N ~ intt~ O~ ~.i.o. .w., C~n o~ to.w, s~~~e ~ ~~nan ~eso~ MO7 ~CHKf MO4,~K ~S?lC~n~ E ~ ~ ~ ~ CERIIFK~i~O?~- .wrw a.. .e.~ .a+TM o.• se.e ~w us~ s•v. wri~f~ .u+e a. o~oio.?«w .~e. o~e oe.rM oeeuuco me ?uce, w rnrsiuwH: . TO ..o..Tw w. nu ~OO<•^~~ oe.TM. ~wu~• o•*e. .•.o. *O '~e us* 1 w~1tMDID iM! 01 r~ cr~p~r~IGGt tiy~ ~ n. o«..s~o ..o.. ~ . ~ ~ ~z~~ ria 7 , 1974 r~. ~ ~ 4 ~ l ~ ~ :~.8 : l0a .o TM< <..,u,~, ~•.~fl ~ CER1tF1U1~ON-titEOiC~? Ex/u+u~ER OR CORONEt o•. me us~s a r~e wou~ Or ot+n~ rMt OKepra ~~S r~p.. ..~eo oe.o • t[ur+~aT:pr~ O~ M WD~ ~~.0'O~ tq wrtSrK,~+~D.i. r~ pw+0«. rOM i ~•t~~ ~OUf OI~M p(CU~~fO W ME 0~=! w0 Cuf ro.~e uuse~s~ s~.reo ~ M=„ ~ t. ` _ , n :M i _ 1 t i ~ CEUiIFtER-NAME mn o~ rnH*~ SK.NAT E ~ 4 a, pg• 4~ ~a~t` O~TE ~{(S++EQi-~ TM. o••. Dr. walter A-. Camp be l l rn' f r f~'. r~.~, 1,^? ~ ,,k 1 7', 1~ 1 r AtAItING ADpRESS-CEffKifi s~ete~ o~ o..o t~n w tor.'r sr.q Tt~rj 3212 N. E. 32nd Street, Ft. Lauderdale, Florida ~tR1A1. CREMAiipN. fifMOVAI CfMfTEtY OR CREMATOlY-NMnf IOCAiION v C~n p~ qww f~~~! Fort Lauderdale, Florida zy Buria2 2~~ Lauderdale Mem. Gardens z~~ _ - DATE ~~Ow~w, 0~~, r1u~ fUNERAI HOME-NA1NF ANO AODRfSS ~ Sn!/~ O~ t.~ O. w0., C~1r o~ ~o.+.., s...e, r~~ ~ MaY 10, 1974 ,s. Kalis Funeral Home 2505 N. Dixi - Ft auderdale Fla. ~ Y. 5. f612 fUrIERAI WREC'fCR-SiC,?~~?U RE('i15TRAR-SrGnwlURf - , Owrt ~tCErvtD ~r iOt~? ~ta~sn~r ' ` f . ~ . • ^ y. ~ • i' ~ _ I ~ ~J ~7 C~ ` ~ .....:-~c rs. c~;a;c~~ ~ t_l a.~t, ~ c._~~_<_ - .ct~~. ~ R c + ~ , . ~ ' # ~ - ~ - ~ ~ CERTIFIF.D COPY I hereby cer~ify the above to be a true and correct copy of the Local ; ~ Registrar's record on file in the Bro:.ard County Nealth Department at Fort Lauderdale, Florida. ~ ~ ~ _ , ~ (Warnin ~ ~3N~}d unless raised scal of the Broward County 1[ealth ' ;~¢q~i`i~q~~h~ is af f ixed. ) ~ ••.'sQ`- : ; . ~ t . ~ • . DpT~iT~t ` ' ' ~ ' , ~ r~~ ~J.il~?%€o~f y%s. ~ ~ r'-' ,R Et l tiTR ~ G ; ;E G? ~ :,c : b~..o i ounty Fiealtl~ O icer and Local Ke~istrar ~ ~ ~ :fl'. C~f?L!nEi ~ ALE : ~ ~ ~ 2420 ~ ~ 1~ 2 .F. BOOK2JC7 PACE A~ s-~s'~~4., f. , ~ , ~ ~ ~ :~-_n r. _ Deputy oca P.cbistrar u - . _ . ~ - ~ ~ , _ , - _ ~ ~ ` ~ _