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HomeMy WebLinkAbout1794 _ _ 7'rJ - 4 4 9 21 CERTIFICATE OF DEATH ' . Deae~newt d Ik.lth .wd R.6.MIi~d~.e Se~.k+e• srwTt f~LC No~ un~~ c~r ~~i.it~ F L O R I D A Ir?E, OR ~llNf IN ~Y~~YR~M~ REGISTNAII~! NO H~MA!!lN? INK DECEASEO-?+4MI aMM~ ~~st SEl[ CAI! O~ D[AM ~ ro..tr, o~~. ~~u ~ SEE WtG{OOt i01 ~ ~ SA~RIET, PARIS DELL ~1ale ~ i~'ebruar ?2 1975 RACE .rm. ~~aw. .vaK.r www. AGE-us~ wa~ ~.eu wa~ ~ w~ OA1E Of ~uIN ~ ro.r.. wr. COUNIr Oi OEAiM ~ "~`r•~ i~hite 6 ~ ~n ~s ~ ~Aori1 1?, 1906 Broxard _ C11r. iOWN. O! IOCATION OfA1M s~ecdh t~s o~ do NOSMTAI OR O'11ER NSTti1Jf10N- ~r wt ~M ~~~w[~, ~M frr~e ..e ..wse~ ~ n 1'es „ Holy Cross iiospital ~ Fart I.auderdale STAiE Oi WiM t N MOI 1M Y.f M~~u CIflZEN OF MA~?T COUNilr MARR~ED. t~EVER MARilEO. SURVIVNG S~OUSE ~~r ~rut. tNe .?~~ee« .raae , 1 ~w., „~q,~, .~est Yirgi»ia`~~ U.S.A. N°O~a°'rr°i'e~°i"`~'~ Hary ~lizabeth Johnson .r¦eee oae.ue ~ul SECUdill Mlw~ER USUILL OCGt~AT10N~~ane •we a~wa oa.~ w~wo rosr a ~IYIO Y N~1N W Kr'~1 ~ W.S~.~ ~ I~11.S1~ Mp~~l~ YR~ fN~~ M ~~NfL OCC~~ffO w ~ ;;•T~~~~~~ ~ry~ 266-54-8525 A Cler~y~nan Chu~ch ' LOfMCt NW1f wwufs~o~+. R~~1pENCE-StA1E COUNIT CIi1/, TOWN. OR IOCATION MMN c~r urei STlEET ANO tNlM~E O ~ ~snt ~ts w ro Florida ,p Rroxard Lauderdale Lakes ~N ~es 4401 N.li. 41 Street f4iMEt-NAME n~ft . r~00~t uW lMOiMER-MADfN NAME ~NSt m00Q Wr „ Samuel - Bell Ona Stump Q7 W iwO~twt~r+t-?+~ _ w?awG /?oo~ss ~snen a a.r~.,a., em o~ w..+. ~•.n. 33319 ~ ~ ?tary Elizabeth Aell ,»4401 N.k. 41 St., Lauderdale I.akes, Florida ~ Q ?Ati 1. OEAiN wAS CwUSED tt: (EMER OMt OPE UUSE IER LNE fOf hl. M1~ ANO f~N ~r~r:••• sea av ~r' ..rea.a ewu - ' ~ a1 ~ d.C.c,~_ ~ • • - . ~ ~ cowa~w+.s. u ..n, ; Q rr~c. e.~e use w !el ~ uarea.~e e•use ~o~, ~~p. a•s ~ Co«feouenc[ or: F in~~wa *wt ~..oe~- ~ ~tIMG C~Yk lA~t ~ • ' - ;c) ~/L~'Ll..r'7C G ssi-%~ ~~ii ¦ OTMEt S~G?+ffiCwrrt COHD~iqHS: cwana.a cawu~~~NG q 0(~M NI~ MOt NY~t~ ~O 4Yf~ 6AFM M/Yt 1101 ~~Y ~ rES rlt( /~MO~MGf COM• ~ ~tes o~ •.o~ ~~uee ~ ~Sa twu ~ w Yes ~ ID~rK.OE.~ Ot~uwOttElK~O A ~~n~. e~~, nu~ Mout Npw u~lutr OCCUttEO ~~MRt IY/Y~l Gi •MWf~ ~M I~lt 1 O~ ~t w, air ~ ~ 2N 7k. M. 7U j , ~NIURY At wOac rtwCE ~f rUtRr.. wr. ~.u., s~en. r.c~w.. lOC/?i~ON ~ s~een oe ~.~.o. .a.. cm w ~o.n.. sr.se ~ ~ ~ wu~r ,es w..o ~ Io.~~ee wn~.. oe. ~ sncr. ~ I 7w- f7M ~ i ~ U[fsKwiqH- +w*« o.• n.~ .a.M o.s .w ..e u~sr s..~ wri~ u~a a+ r wlao w. ~r.~. au' :•..rK OCCUeeeo .f o~e ruc~. w~+e ` ~MrSKUw: ra.m w• Tw ~ow urN a•m. ~.~..r,~~ A c•,~. u~w. w~e ~es* i ~~ne~+wo r. T~ p W rt [r~br~tOGl. O.+! 2N oecuu~ ~~r.e. j2N Z/ Z~ /197rJ t~i 2 1Z 71/~ 711. X(% '~d r'J:20 M~o nK wrsas~ sr.a~. ' CERiY1Cw:IpN-MEOKwI E1AMwER OR CORONEt- w~we wa o~ ne ~ p a.w~ M~ OltlOtM ry np..ou..ceo oe.o ~ ~~....,e~o.. a.r wo, ..w~c~ r.~e ...fsrc.~n». w.. o~..a... rwm wr nu wow Ol~w OCtWNO Or+ 7Mt ~R •~+O cue ~O UuSl~s. sLnO. - ~ K t2~ M CER11fIER-wwtE ~nn w~.~.•. -----y~ SI(',NATURE v~ otwte w nne :OwTE S~G~'(~~+o..n., w•..eu~ 7b L t/ J A I~ 4 , ` ~ `I i J l~ti[rL~G.r.A ~.vC ~ . ~ 2k P~ ~ ~ T - ! ~ MA~NG ADO~FSS-CE~IIfifR s~K~r w~~ s..o. cm a wr.. ~i.n i~~ 4~59 A'orth State Road ? Plantation Florida 33311 ~ WM~L. CRE~uirOr+. aEMOv~I bNEtERY OR CRE~iORr-H~E IOCwTWrr an o~ ~c.r.. wn \ i SMCI/~ I I3urial H?Lauderdale Hemorial Park Fort Lauderdale Florida ' ~ O~iE r..o~.*., o•., .e•~ ~ fUHERAI flOME-N4A{f ANp ESS o ~ o no , e ~ sr t~ ~ ~ Feb ruar~. 24, 975 „Faniun-326 ~~s~~.as O~as ~~.vd., ~aud"er~ale, Florida 33301 " S. i ~ i 7 t~F.Fww t~Y ~ a~ 7J~Ti. ~ tEGI A-SlGIJ~ci(Jtf OA(E rv[D IOC~~ ~EG~3~~~~ ~~~.~9,0 :-t-~ ~ - isi~ v . . ~ /9 ~ ~ RECOROEO IN THE Off1C1Ai Rf • ~ OF SROWARD CWNTY. FIORiDA • 'i~ CERTIFIED COPY A• R• gAUTH _ ' COilNTY ADMINISTRATOR ~O o' I 0~ j hereby:.~¢~i'~~f1~{~~Iie~. ~bove to be a true and correct copy of t~e Local ~ Registrar''~SS rd qrf~fi~ls in the Broward County Health Department at ' ~ . - . _ ~ . f" ' • t ~ . .s., t C~ ' ~ Fort La~:tdaI ' ~ _ _ w .c ~ " . ~ % ' 00 (Narwipg; L~~p~~y~tlyceriless raised seal of the Broward Cour.:.y Health ~ t.i. : rtA~~¢t~n~tt ~"is affixed. ) ~ s4 aN ~~5 •..~.~~~t~ m i ~ 8 y,,,~,~s ' 2-24-75~,' - . - - ~ ° ~ au ~p ~~CO;~~ County Health OEfi cr and Local Registrar r`~ ~ • ~ " d00K ~ PA~E 1794 a~~ a . rj . ,L l~C'iG (~o. vous~~c~wa~i.F?~ sr , • ; '.~~EB, COLE, SIGERSON, MCCOY, BELL & BOND Deputy egistfe ~1~!'3`1 '~~A~rrot~~rs ~T Lnw - - ~ ~ . P. O. BOX l01 ~ R~ . . 32015 ~ _ . . _ . . _ k - _ _ ~ _ a. ' _ -~,«}c~ '...-_~a_~ ~