HomeMy WebLinkAbout0661 / ~
~ ~
:
~
~
~
. DEATH CERTIFICATE ~~'~8~4
RE: Lot 1, Block 58, LAKEWOOD PqRK, UNIT 6,
according to Plat Book 11, Page 7, public ~
, records of St. Lucie County, Florida.
. ~
BALTIMORE CI'!'Y BEALTB DEPAR'TMEltiT
BUREAU OF rITAL RECORDS
~SEP 3 0 t9F9
o~n~ r~• c~-y
1 ~ MITWtORE GiY HE/LLTH DEPIIRTMENT , ~ a f-
~ ~ /(c~ t,. ~.~JJ ~ERTIFICATE OF DEATH '~~.NO, t~,,__
. r 'v • ~C 6lRTH NO.
~ • Y L v r_~__.~
`1 E U OF DEAi
n-o i c u~ troe e. r:.~~ D~~.,~'R~ `J? riA itP~~ S6p71E~6t~~t. Iifc• ~1 12~~ Ptit.
Y~ 1 7, KACE (N ~AL~E MAltIAND? WME~E ttONOUNCEO DEAD L YS'UAt ESiDEN E i w~eceoscd ired. II iss~iNkcc ,esi~snce Oe1o.a odm:ss~ewl
r. 0 0 O Ib SiATE COUN/Y 3f
' " Mar land Anne Arundle
FUII NAME OF Of NOT IN HpSHiAI OR iNSTtTUAO1~, pVE STREET an Y ~n D. INSIPE CiTY 1~~5 ~
O~ HOSMTAL OR ADDRESS OR tOCADONI ?
` a~ C p ~Nsnrunow . ~ 9urnie YES ~ NO ~
o`- o ~'o N,v S~t Ic~ P ~~C ~ rif5 ~~c~5? ~~rAer -
o•_ , 1 0 3 L e
y m e r R o a d
. . ~ . a e .
• Ij C 0 0 S. SEtt tACt •~p~ ~~~p ~ OAiE f ~I •f1 ~y:j*s~De~i ~ Ho U~der n.
~ I s ~ ~
~~~E o~„ E Female White wwowEa? on?oRCEO? 5/8/28 41 ; ; ~
O O O 0'- ~oA.USUAI OCCU~AT10Nl ' O~ttND IKESS /NOUSTtY {l. ~I~i11 CEiStd~ N 'Y~ covdry) 17.G112EN OF WNAT GOUNTRTi
doM dw~.~ ~or d~raliN fiM. ~ 7~Min~l
: 'O C ~ ~ ~ r
o H~use-wif ~ s, MOfNEi•s NwaH nN+e
a a d o 17, tATNit'S NIUME
n Henry Burkhardt ~~~j~~ El~anor Moner
~
O ~ ~ S? •s ecN~ . «csa SOCtAL . IftfOtM1WY ADDtE
9 D~'~ e~.w a ~akwwd OI ysc, ~i~~ ra+ ~t A~ss e( sewicd SLCUtltY NO.
L
No ~~RS 180-20-9720 Mr. Geor e A. Har sr (husband) Seme as 1/y
~"p O t 1~. F ~ /Jf107t~MA7E INiftVAl
L O,~ p ' ~ ~EiWFEN W+SEI IIND DEAiM
a DISEASE Ot CONOiT10N OiRECTLY ~
~ o~ C',~~u~N~~,A oF ~ 8~ns~ 3Yes
O~•• LEAOING TO OEATH ~ WµEOU?1E t~11SE
C ~ f (TYis does ~ol aiso~ w~ mod~ oI dpinq. ~.y. ~pUE i0, OR AS A CONSEQlJENCE Ofs
~ O~ O beuA tai~w~. asNwao, Nq p m~oas 6~ diseasR.
, o L a o.a injuq a compGtaios a1ac6 toosed dso~J F il( L r~,'. r•~~ r j?~8
O O~ O ANifCEDENT CAUifi ST iU: f ;ciliT~ f~,A,
~ ~ Q~~~ DlSEAS[S OR CON~ITIONSi, if aer~ giria9 D1lE i0, OR IS A CONSEQi1~,NCE OFs :•_f;,, : ^,1} ~ ~ai~Rr ~
j x-~ = O r.:e to tSe aeon eaess W sbfin9 kECO.
I v ` a C UNDERCTING COHDITION (ast (C).,. - ~ ~w~ -
~
~ II 4Q
; _ ~ ~ 0 OiHERSIGNIFKANTCONDfiONS CONT1UBlfi{NG «~T.....--_«~~
o~ t C~ ~ TO THE DEATN eui HOi REIAIED TO iHE IERW NAL
fi O 0 Q DISEASE OR CON01ilON GIVEN IN Pltti 1 IAl.
V 19A.DATE Of O~EtAT10N 9 CONWriON FOt WNICM OtERATION AUiO~iYt ~s « p If 1 WEtE fWpNGS CONSIDElEO
. Q~ M~ ~ Ai tEtFOtMED NO tf Ctt11f~N0 CAUSES OF OEATl13
~ ? ~O ~
7~• p''~ ~ V 21A. AGpDENS WAS YNDEl11?Nd 11~1LACE OF INJUlf t`p. N o6ed WHER[ DID ~1 le 6dWnw~ Cip. y~+e eaad bco6a~;
~ a... Ot COHTWUi1NO~CAUf! Of Mrse, ira~, foe~al. sreK ~t Mdo„ INJUtT OCWtt
p v b O 0 ~ OEATN 4otf~ ms6cd eaaai~ei ~
~s ~ ~ s
4~;~~ O Z 0.i1/NE fMee~63 / 1/Yeei tHoa~ lE INJURY OCCUltEO F. MOW DID IN1Ulr OCCUR~
Y 0 a~ C ~(Af~ROX.I A! ~ Nol Wli~s
w.~ D
~ ~ ~o o ~-~?~1:
~ c o p~ . 1 csriifr Ihaf 1(this l~apil_al) ottMdsd tiN d~t~as~d kan ~~9~~-~--.-_ ~.19~_'~ '
s---~T9
. . v ~ • ii~
e o o=~ 4at~ i~st wv'~~i on ~ ~ 2~ 19.~.~end thet In(~ ~a+r) oPtnion deoth occu?r~d on tir dot~
4 = O~ ond 1 us o fre~,3fr cou t~d a (M~) Idl~ (dld not) vl~rr t1M bodr efN? dtatl+.
N~ M 1~ A. SIG f, DA~E GNED
~ O.~r 0~ r • ~
D ~ ~ ~ E _ ~ ~ ? Dindoa ? ~ ` S~' C
~y ~ n oeeeec
~ d~~ 2~ IMTfIGA f - 27D. ADDtEif
p p NAME t~lOd k O
C d'i. ~ 1
~<d dd Rober~; g, M.D The 3ohns Hopkins Hospita
~ 0 24A. ~Utl AilO ' C,NAME d EMETEtT N C~EIVfATOlT ~0. LOCATION ( bwti ~t ueMr1 lSfnld
~ v Q ~ ~[MOYAI lSpcdlil =
oNd p"i 8uriel 9 6altimore Natianal CemetQ y 8altimore~ Naryland
O O p~+'~ SA. OAt t[Z'G~Y H[A AME OF tE fTtA! 25C. fY
• rM3-~v3
vs iso-a~.'14!'YS IS rpNY1,ANQ. •
IN ZHB 8AL'1'IMOAB CI1Y ilF11L'ltf D~PAt~I1iD~t?. BA1.'i'IYOitE~
MAR.NING: DO NOrC ACCEPT 1HIS 'IRANSC~IpT SI~N BLUEIAL DEPAH'I~IE'.YTAI. S£AL
IS AFFIXED HENEON. PLEASE N01E
. ~244 ~ 661 Q'~s M.o.
60
U OF VI1'AL REOOt~B OOMMISSIONFA OF HEAL'1~1 AND REGISTHAH
DI[iF~C'IOR.
~
~ - - -
. -
_s~ . ~.s_~.~.~ _ _ : . ~ ry ~