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HomeMy WebLinkAbout2967 . ~ - ~~1zn ~E~.c~ C~~o~xt#~ ~~.t~ ~~~~r:t~t,ext# 2~~~ CERTIFICA7E OF DEATH 3~3"~'3 3ney..,.~.1 01 ~le.~t~ .wd Re~a6i~ih,lre srrvke. erfA,rE l,Lt llo. nnv~xxv of ?~?~n+ . F L O A I D A t rtc, OR ~1~NT IN "'~1°~`w"~O RCGfiTRAlt•9 HO. ?i21~~}ItNT 1NK ~~Aa~_~~ rusr r.aae ~~u ~ DA~p~p~TM ~wwir,~ar,n~?s~ SFf 1WW~FA~ fOt ~~'p'~ SHELTON R. S1~.OAK JR. :.I~'~Ie ~ Jul 5 1974 ~/?tE M~oa~. •.uNCU. rMOUw, AGE-u~i u..a~ ~•t,~ u«w~ ~ e~r 04TE OilhTM ~.o.w., Cd)MTY W OEA~H _ e*c ~ vrcc.. ~ wa.o~, ~.u~~? ,+ot. w.t ww~ ,.u. •w ~ ~ White . 62 ~ k , Dec . 13, 1911 Yalm Beach Cm. tClwtr. O~ tOUTtON O~ DEAM ~»LOe ca? ~~+.~n NOS?rt~l OR O:ftE! NStrtUiqn~NA~ME /N wp1 IN ~1nyl, c~+e sran .wwr? s.ecu~ rno~,+o ' „ West Palm Beach Yes St. Mar s Hos ital s'~rE af MRff~ ~w »o+ N. v.s.... ....u ntEN Oi weuT COU?+ntr MAtMEO,1:lvte MJUlNfD. SuRVivnGSlOlt3E ~d tiw, aw~ w.ra. w~r, oounm~ WIOOwEO. ~wc.n~ ~w........~ So. Carolina U.S.A. ~ Marrie~ Barbaxa Pickers iIl ~ SOCU? sEOU~n ?rtlwFt uwnl ocarATIQ?+ ~c~v. c... o...o.. ow. a.wo ros~ w 1Ca+o oi wslMEU of MOUSnl,r ~~v~p. M ~lASw ~ - occuw~ e,~ r+wao.o uw, eveu r nnw ~ '"s"'""°"• - 057-05-3162 u,_ Executive ~a. TextiZe flYW~K.! MMM. .o.us.~ou_ eESwEHCf--suTE coV~+rr trrr. To+vr+. of lounOt+ w~w. c.. u... srREEt ~ v~cr+ ns w .w - Florida ~w 'tartin Stuart „a No ~k 115 St. Lucie Lane FwthER-NAMf nesr aums uu MOTMER-MUJDE+1 M~MIE ~~w +wo~l w~ _ u She3toa R. Smoak, Sr.~ Ma Aq~n INiORMANT~WMAE ~ . ~ MAQWG ADOiESS . _ isueer o~ ~.r~. Mo.. Cur o~ qvM, t~a~e, m~ Sarbara P. S~oak ~ u, 115 St. Lucie Laae, Stuart, Florida 33494 ?Mf 1, p~TH W+~S GbiSEG 3Yc ~ (NViER O~xr oNE GuSE ?E~ ieiE iOt (aL fbf. ° • , Nrwur o.~sn •~r .,....n..~, st ~uc~E ceuKtr lA. . ~e? /1 !..l..t-tiD~-t-lt . RCCf : ~C?!TRAS , ` ` . RFCOR", ~r~r~:Fif.p coNwnoNs, .r ~.n, _ w~~tM a.ve uf~ :o (6{ IrrlO/A~f (~Ylf ~Of, p~ ~y ~ COMfMJWwCt d: ' s~1~TIMG M! YMO[M . a~~~c uuu us~ (c) ' !J?tT 11. OThER SIGNIF7CwNT CODtO~TWptvS• ca+ana+a co~ww~u~+.w ro oe~cn w~ rwt nurte ro uuu u•e» ~M ran ~ w~ ~~r if YfS ~e~e hMaMOf c ~ns o~.a~ ooeus eett~.~w~.w Yes Yes ~ iv+ebobt~ ~1CUDsYT, Si1~G3f :rt Dw~~ WIWT/ ~..O..rw. p.r, ~e•~~ MOUf MOW IVIURY OCCURtEp cewna w~swt w wwn iw r.~r ~ oa ~ae~ n, ~rt,r t~~ /AMtGD~ Q! 4t-0EiE?NV.fD G ~ ~ , 19r ~Jt M I01 • iN3li~y AT WC~X i'.wCE OF !r~.t;R~,. no.?, s~~eer, r.c-o~r, ~punpN ~ Sn[tt ot r.r o. ~0., C~n OR tOrn, uw~, ~ vec.n *es o~ ~+o i oN~ce +.ao:. ~t. . vic.n ~ ?H. 2~? ~f CERf~HCATION- .owTw o~~ ~e~a +.wn~ o~• ~.w usr s.r »~/nt~ .un o.~ ~ ow .aM.mn+ nr CEwTN OCCUNEO u.! n~c.e. a+ n.! /MTSKtwr~_ TO ~~ne..~w n.t nwe ~oo• .m_ ~.ov~~ o•n. ..w. ~o at n. ~e«.:to ..o_ I/ G, t~n 9~/ :it. 7 S- 75~ r.~ ru S: 22 v»', ~ CfRiiftGTlON-7~+FDiCAt EZAMtrIER OR CORO+~ER~ o.+ r+r s.us w rnt 'qu. o~ u.n. ceccw.n .+.s r~.+a:..cee ot.o ta~Ww~tq.~ O~ twf ppf ~rM/M t.t M'~tl*~+~i~pr. tw r1 O?wq~. r6~M O~f rlaf ~.py~ Df~m OCC~Mp Ow Mt Dwt! w0 ou! fD ~wt U~Sl~i~ f~~~lO. .r. M m ' tfRnhER-wWE „+?e o..~n.q - StGNA LRF. . T I, wc.ee w~~ne DwiE S~Gr+EO b.o..n. a.~ ~w~ 1A ~l~r`~.Zd L• ~1~1~~t vr ~ 1'1 • Y1! J'i~1/~~'f~• M~D• ~~llly O, 19~4 MAttlliG ADO~f55-CfRI~HE~1 " srn ~ oe r.~ v' n o~ 28Q1 ~orth ~ gler t~est'~a?,r~ Beach, I~orida "33407 Wt1ul, CREA?~?TiGN. RErK3VAl C~F:ct'f Ot CREMwtOfif-NaME tOCwAON / Urr a ro.~.. St.n " ~ s.tc.n ~ t.. Creaation Delray Crecaatory :.s Delray Beach, Florida OA?f ~..tr.r+., p.~, tt.tr fLNEAA! HOMF-NA.wE INp ACf~1F55 i sn~er o~ a. ..o , cm oa •a.~, sra~e, r~a ~ ru Ju1v $,~QZ ua eba ~-Burse 1201 So.01 ve W.PaI~t Beach,F1. 33401 v. s. s~ ia FUrhiEf~l c~ECTO sic.nuluaE ~ . - ~ ~ ~.a .r o a. .i ic ~ i. Rev. 29T0 ~.~y/~. fl ~ i•'..:.. • ~ tS? : ! ~ i _ i~i` ~ ! t~ ~ _ / I~it=.BY CE?TIFZ ?'ri~. ~190[~ '~'J B~ A T~ A:ID C~:2F~CT~~('~.~(3I? fi?HE ~ IST~R~S R~CORD fJa1 - ~_..s r ILE Itt THIS 0~ FZCE ' _ _ . (Not va3,id unle~g the se~-~ ~~~~.y~~ ~ ~,a:~t " County Health ' ~i*^ ~_'T/.; , . - . Departatertt is affixtd} ~~Q~.t~ IE •~f ~ • , ~ 4 .:.i; j i~ -t } 111 0 K I,dC~~• 392 v~rF1628 - Bur~a~~ Vtta~~E~ti9tics g00K~~ PACf . West PaLa•.-8es~h, Flor3da ~ ~v~~ - . _ _ , - - - -t;::~,~,-~~ <,y w = - _ ~ ~ ~ y_~ . . a