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HomeMy WebLinkAbout0771 : , OEPARTMENT OF HEALTH AiVp ftf:H:~81lITATIVE SERVICES STATE OF FLORIDA • DIVISfON OF HEAL7H i3;1r~~U9 _ Alachua County Health Department Tetephone (904) 37&5.321 P. O_ Box 1327, Cainesvilte. Flarida 32602 i:. C.~ ~ ; 4, y3 CERTiF1CATE OF DEATH ~ Dep~dww~ o~ ~te~l~~ ~ml ~'el~adillh~lre ~sricrs ~'iATZ FlLS a.•~sa~ or- ?~F+~n+ ~ F L O~ I D A i • Ci ?l~NT IV uv.~s~wra?.r.ee . REGI6TNAi~•9 NO. F: ] yla~itii IYK `~~~5~_N~Nf NiS~ ~t 41i f~~ SEt DATE Oi CfAM ~.~or~w, e•r, •~.e ~ p=Y ~ JACOB r~an HEFFEP.S ~ MAI.E 1~ r~1RCH 7, 1975 RACF ..vn, w~wo, .wnc~w uwua, AGE-usr L~e~ ~ nw• wae~ ~ wr Ow1f Of l~tM ~..or.n~, e+~, COUNTY CF OfwiM !'t. ~ S~tCMt 1 ~~~tMO~t ~!l~~fl wpS. Wtl MQ•I!! W ~ ' ~ W~'llte' y~ . 72 L! t~ ~ r { ~7 ?a . C1Tl, TOWN, 01 LOCwf10N GF DEAM a.s~ae r:n n..~n Mp~ ~y•T C~yry~~ '1'z S t~OH-~LWt 1 V e.pf ~M ti'M(~~ 4ni 1rKlt ~w0 ~;yM ~ f~, / 11l~1/1 723 O[ NO [(:J~~~L I Gainesville 4-•- _ r, , Florida yes u Archer Road Cainesvilte~Fivrida c- SiwiE Qf ~:atM ~~r ,.or i.. u s... narr CITI2EN Oi WrwT CO!lr~fiY ~Ui t!fp, r;Fv~R ~wi;eg0, SuavtvLVG SAOUSE ~ r.~rt, c.+r ..~we.. w~..~ ~ uw~.:~. ~ w~now~o, o~vOzCf s.~.. ~ . _._..s.::~. ~ P~nnsvlvania . U,S.A~ r,~arriel tia Cetz ' :K~.~L] ' .s'_.__'_'. . _ S~~~l SfCU~11'1 M1~~FR USUAI OCNfAT1pN ~u.e cwo w.c+i no..t ovn+~ a+cu w ILrq pP ~WEU OT It+OUi~T -~~e.~ ~ rraa~~4 urt, dt~. ~r ~lr.~M 1 ;,i„ ,t 080 Oy 6692 shoe tanner ~r tannin~_ R=s~~eHC_-sr.+sF eou~nr ~ - arY, TOwN. O~t LOCwT10?a - ~sat crtr iw~s s~•~r tivo .+~,.~a~r ' ~sneu? ~es o~ wo~ Florida St. I,ucic ~k Port St. Lu;.ie ui yes 10 N2rnando ;venue iw~ncR-?+.?w~c ~~nr r~axe " usi MOtH~d-M.~+0.~Y N4~+f nasr r.aoce u~r ' - ~s Williaei H~ffers .e•. Eertha ::a Stine _ ~t~tFO~NAl~i-M?~+.~r AuiWG ACG?FSS ~s~tzi o~ ~_r.o. ~o., cm a ro.+.., sr.ie~ t~st VA Records ~n V.A. Hos ital Archer Road GainesvilZe, F1. ?~it 1. p~iM WAS CAUSfO 61/: (ENiF~ O~+LY C.`tf C~' ~ N`t (o). (S~, A.vA (cj} ~rr:on...: t.; ; , stn.!e« o~sar ~w eer MrlO~~R 4Y5! ~ i ~ a~ Coronar Arter Dise~~ 8~ ~~~j R ~ ' e . O~ wi ~ t ~SW~iH.[f r CON'~Ii~OM). 1? aM~~ ¢~Et1 YE O ~C~~V~ 't rh.cw c~.e us~ to ('~I Aortic V11V@ Disea~CBR a,~! ~ 32 a IrrlD~~f! C~Ytf W/. ! O~I t'1, Os w~ w COwSF~.a.~C! p: ~ . ~i~tlMi ~F! YNDff- ~ \~~MG C~YS! lalf ~ ~ ` _ <<~ Renal fail.ure _ _ _ _ _ - _ ~ ~ - 1AiT li. OiN~R SI ;N~fKANi COf:O~fIOr+S• et.+ar~ts~s eo.a~.wL..c ro oe.n. r.r .q* ~e..~eo ro c..vu e~rn. rwrt ~ ro~ A~T~~ IF YES vest n.w~?.ss ee ~~:s o~ w~~ s.o:~w u. onraw..u.a w • cr ourw ' b tD i?. ~ ACC~~~rr1,-4iK~n'e ?N OwTF ~WRI*Y ~..oi+tw, o.., ~e•t~ M~t:3 ~+GyrU~ O2 u.~OttiZwre!D HOW IN/U!T O~CVRAe'~ ~ e~res wwx a n.wn w~.a~ ~ u?ur r, r+e.. u~ I~a!fl ~ 7.ie Y.i :n µ ~r' ,ii y . I`UURY AT WC~< iIALE Of L~IHiTY ro..~, s~n•r, r.v_ro~+, ~~CATI ~N ~s~een o~ ~.~.o. no., an o~ ro..M, sr.n ~ 1]/tC~R G~ MO~ p71rC! ~WG.,[:C. ~LfCVt~ t:f Y~ C~T~HU110»- .w•w wr n~~ w~n. ~ o.. •raa .~a :.sr s.~. ww~.KS-~rr o.. ~.y_ •aw ..o;~new n.r OTw?» OttuNt7 ~r n~e ru.'t, ow 1M~, : ?nriK~w+~: ~ TO I rc..~,. e•~ n•. soo.~i~~~.r ~rouat Osn, ~.~o. ~o o~! M ~ ~~m~oro iwe e . O• r~ e.ap.ru~, ~ o.«.sfo..o. Eeb_ 2$ _7,2Z.Z.L~~?_~_7 _191~~:~, ~ ~~ar 1975::~ ~c1~t3' r.9:30 .ar:~s...~...~E ~ Cf7fIFlUTIOH-lr:p:Gl EiAWNcR O~ CO~ChER w.r.: ~,>.s O• t~r ~.;ur Or oe~:~ er~ ~.~t(~~tiT y~l /1QM01}~[F^ or+0 ~lYU~~TM~ O~ iw! ~GO~ ~!A/O) ~~f wv~ST~~'t~. M+ Ir~ pLVqY~ ~.'}~T~ ~ ` V"- C!~~w OCCV/M0 O~+ M! O~~t ~+D OW PO M! UVff~l. S~~T_O ~e ~v~ F ~ ~ ~~1 ~ 1 ~ CfRT~f~ER-x~.uE mn os .~•~r~ ~ ~ - - - 9~ ;~:._~i~-._~ - ~~7A s - . ^f~ t ' / ~ ~r:,~tt w t:ni--~ ?I1TL ~••o..o-, o~r, rw ~ ~ 72a __~r~'~iT~i.J.411__~)~Si2i~~I1_y,~i ns----- - ' ~ _ ~ _ ~ . _ _ i~ - - _ ~u~::riG we<<is--c~r::.:n Snee: Oa t~.c r.n 'un e~iJw-. sr.'! n• ~ t=~1 A ~nSDlr1 Cttnr ~~t i n~^•,~' 11~ F1 ri~1,~e ~~~i S~:7t.~i. GPEMA7fQ;I, R_w~pv.*L CWE~ERr Oz CeEwai;,xy--r~.:~,.p IOCwROU t+a o~ ro..+ ~~~q ~ ~ •JY~•I r _P.er_.~oval ;.,Fa :t Coast Crec~atory I,~ Jacksonville, Florida ~ ~ I'•~ DAT[ . ~r:-~er, c.r, riu.---- f1it3ERAt HOME--t:4.MC A~~7 iDD?FA i i:•en u~ ~.r.o wo. e~*. e~ to~.v, sr.•r, i~s~-- ~ rN ?iar. 7 1975 ,s, ~•;illiar~s-Tha~as Fu.ieral !io~ze Ca;nesville, Florida ~ • . fv~°aM G:~ECtOi -q~r.it• ~p ~ ~ ~;W"i ?i~ l-s;~ r~~~ F //1 t/1' o.,i ee!ntd sr ::,twi ~eG.scr.• ~ . - - - ~ ~ _ ; '1 , , = - :~-~l~~...a..~ .~1~.~~-~c._. . '<,=.4:~, 1!3 s/,•`r_.t . , l,. ~ ' ~ < < . ~ I HEREBY CERTIFY TH ,~180uE~'~O $IfA`•TRUE A::D E?{ACT COPY OF THF, DEATH ~ CERTIFICATE FILED #~~~flI5 UFFYCG•.l . ~ r..~ MA~ 1 3 tyl~ t;~ r~ f~~' lE f. , { ~ . BOuK247 PAG[ ~DATE) Sr~D;ZA A. DELISLE, DF.Pt,*CY REGISTRAR • .~;r-. - __u.. _ . _ ~