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HomeMy WebLinkAbout0019 CER711- ICA7E U1=~ UCATF~1 ~ I?.p.u~~~~. ~.l ..1 11..~1~6 ,,u.) I:. I~..I.,L~.,II.r f... BTAI C F ILE NO 3~ ~ tM\I.lu\~N FLOAIDA ~ . ~ r~ n~ r•••••••••••••••••••• I)If,If,T11AN 9 NO . ~~toi~r.ri2e~~ u~K 41Cl~.lU ~r.aM/ . ..i~u.~ ..v :•.li ,U~tl Ulwu~ y . Slt Y~~::iU~l iLl j ~ ~ ~MS11J(11~I1S s• ~ j~~~•~ . ~ Jacol~ .~andlcr r a•.ale ,~.ovember 1.1 , 1 1_ ~ - --f - - - ~ f~Cl .e..ti ~ ~(.t ~.Sr ..~.n ~ ~ io..ni~ ~ o.. ~ Cw1E OI ~;~h1 ...~».~r~e.., ~((lUµtl OI Dfwh~ ' ~...,.0..?1..,,~N.~, o ; 3 ; . ::hita ~ i ~.Dec. 2fis 1~)0 I P.roward _ ~ . Crtr 'Ow~+. Ot tOCwLO?+ O/ OE~tn .~.+w~ e.n .r.n MOSh1Al O~ OMER riSh(UIION-N~M~ «o• u~..~~. e~n ~nen .~.o ..v.u~ ~ { sr~cu .h o~ »o 3 ~ a n :iolly~:ood Yes „ liemorial Hospital _ _ _ _ - - - , - - - - - - - - - - ~ St~iE O~ ~~~M ~ u»w o ti•.•••~~ ~UTIIEN Oi WNAT COt1NTRY rwoo~4D. ~+EvE~ M~~RiEO. kSutvrvriG SrOUSE ~~•e. e~.~ ..w~r ~ ~ cw..~~• ~ +~~OOMrEO. OrvORCEO ~ v~cr. ~ ' ~ ~ itu~~ia . U.S.,?. i,~ - _I•.arried L~elyn Dlugasl: - ~ ,-r, ~.~~a ~~~1 SECUCrt. r~UMEtR ~uSUwl (KCU?~I~Oe~ .,•.o o~ ~c~. oa+~ ow~..c ..m~ o. ~ . y ; i R~r+D O~ WSwtSS Ot u+GUS1R~ i .nn y ,.o~.~~.c n~.. .amo , i • „ - - - ttet. Self-~•7nployed Grocery -L----- - - - - - - RES~DE?+CE-S~aiF 'CpUN?r . C~7~, tOwN. Oi 10CAt~0?~ }~+s.o~ c.o n.~n Si~Elt wt~D ?~UM~t~ ~ i~~.~c... .~s o~ ..o.l . l'~1~ ~~2"O:tiard HOll}/'rJOOC~ li~~ v~'S lu. 2j~~~ P?1'! T_..3P.n ~~TMt~-~~~nrf .~n• ..wou i.?, MOTNEf-AUWIN N~IMI on~ ..~ooc~ „ Josez~h Sandler Lena (?Ft.~ } ' ~ ~?~rONM~wi-r:~va( (wuMU+G wOGtESS ~»n~. o~ o w. ea. w eo~+, s..n. ir~ : ~:vcl~:n ::~ndler 4,n 2j~0 ~Yar~c L~ nc, 'riollyt~ood, HZa. ` ~ ~~~i 1 •.r~:u~~4ry ...ry~.•. OEATM WAS CAUSEO ~Y (tNr(e pra~i O++i C~uSE t~+t r0~ ~o~. ~e). ~~+D ~c~~ N~+I~w O~H~ ~~O M~~• 1~ rr~O..ri <i~ie . . ~o~ h~c,';' ~ , l~~~?r ~ C. ~N~=U~ ~`S U~~ r' r~'~,1 v~'1 S ~T~B:-a. :i . io•.uou~~. o ~ f .~.~o~no..t n ~ c« G..e ~~s~ to ~ ipl ' ~ rwfO~~1! C~Yt~ ~0~, I OJ~ ~O. W~1 ~ CO.+f~OV~~+C~ d _ _ 1t~1~MG YMOt~- . ~~IMp (Ayl! l~S~ • .r. ~ ~Mt e OtnER SK,r~!r wni C0++0~1~pN5 coro•*~o..s ec.,a~a n.w ro oar. n,~ or nu.eo ro c.~a a~.n. , co~ w1JiWSr vES ~w n.o~.es eo~ ~ ns a..o~ io~uo a+a.~~~.ac uus NC,,L~ ~j ~~,,vG` ~ o. e~.,~ ,:o ~i P•et-~'d •CUDP.t, SU~C~G! W bAf~F-MUURY ~ rO~aw, O?- •~-~~OIN MOW INJUI~ OCCURREO =~~r~~ ~•ruh o~ vu~~. ~r i o~ r•a u, n~r . M[;MI~~pF. C~ U~+OtIIfMINlD ~ ~ ; ISO+c•~?) i Y'O J0~ 70. r~ ( 701 INwRY AT WQRK-rAACE O~ M~)Uft ~:~r~, ~ur, SttU~, ~K~W~. LO~ATION ~ 1•~~O O~ o r0 , Vn O~ ~O~w. St.q . j ~ fr~C~rr ~~f O~ ..0~ ~O~rK~ MDG .IK ~t~K~~~ ~ i ~y~ j7C, ~20~ €EE CEanftUS~ON- •~e«... o.. •e.. ..o..n. e.. .e.. .»o uv s....~..~.u-+u.e a+ o.~;o~?«o~ r..~ ot~tn oetuulo .r ~uu. ~r- IMrSIC~~N - ` ~O ~ rO,+rw D~• .f~~ ~~00• ~~r1~ Of~rw rWu~~ ~ D~If. ~~.D.'O ~4 ~ •rr/~ClD t.~~ W 1 \ X"~ O~ ~tiO~t104f [ f ~ ~ ..r ' . .~i~ _ ( ~ 71• oe:e.~~a n~ ~ ~ / 'St~' • I f ~V '7!: ~ ~ )1~ ~ 7q l/ ~f1 M ~p rq twu~s~ s~.q ~ CEetp~Ui~Jk- NfD.C~I E?~M~~.EO OA CO~Or+Ea •.e ~.a~s or ..o~~ o. ee.r.. ~ r.e o~aa»~ ~.s .~~.wu..ceo o~•o ~ e.... ~..r.. e• ...r ?,o. ...o'o~ r..~ ...esrv,.•o... e.~~,o... ~ ..wT. o.. .ou~ oe.~+ o~iwna c-. o.n .~o ow ~o c.vv~f~ t•.reo ~ ~ l:s . . . . _ . M~7? " _ ' . ' S~Gh~iu oio•e~ e• +•ne ~D~if SIC~++EO ~•cw*~, o. u• CEiflf~E~-r~~wF ~...t o~ .rw.: ---T------ - Roti~rt Glasser i•:.:i. L ~k 1J~~-~ ~ Mw4u.G wOOIESS -CEihHM iine~ o~ c ~o ---~~n o~ •o~ s•.n r•. ? 1131 :?ort~ - ~ ~~ve. F(oll ~:oou' F1a. ~ ~ IOCAiION On O~ ~0+~ V.t1 ~VRIA~, ~NEMAIIQN, i(MOVA~ ~CEMEfEilr OR CRfMAiQ11T-N~~a~E - ~ veto• , ~ . ~ n. Re,~noval i,~~ KinE; David Cenietery Palls Church_ Virginia _ o•• .f•~~ ~V( fP~l HOM L___ D~iE . E-~+~µ[ ~r~0 ~[S5. -ue. r. ry0. . r s..r~.t~r'~. ,.,I•:o~?.11 ,1 y~15 - ,s :~lverside i•Ier~.~na ~1e1 ~ ~i +:.~~:~f) ~J. c.. ~ ~ f ve. ~:or ~h i :i?r,:i_ ~~~h. ~ FZa. r i.' fUNtB)~I D:RECIOY-SA~LN~I ~{r. ~ YtGIS1AAR-5~"r.+~l~ f ~ o•rt ¦ecE~veo ioc.i ~te~s/r¦.~ ~ r 19?1: 7t! Lh t-t• .'7 . ' ~ ~ .1~ 1N ~ 7N . i ~ ~J ~ ~ ' ti ~ ~ . ic" - ~ . . . ~ ; ' : CERTI FIED COPY ~ , • r<t ' :i~f it~*.~`:::,`:~ ~ . - ;.-.~~,y , s ~ I hereby cert~~f ~C~ea~'e_~lON "~o'-:be a true and correct copy of the Local Registrar s record ~ r . . ~ k . . ~ _ ~ : ~`;Jw••/ . . ~ on file i~} ;thT BR,o~~r d~~C~utiCy='Health Department at Fort Lauderdale, Florida. ~ j ?~r~t:f3 ~ '"=r g.. ' uN08~ of the Braward County Heal Dept. is affixed.) ~ (Sdarnin . ~v~li~u~l. ~~If CO tY r.~..~ . ~ ~~t~' ~ rR46E1? FO?TR~S i~~~ ~ . C~EaK c~RCU~t coupt ~t 12-3-75 - RECORO VER~FIEO~ un ea t cer an oca egistrar ~ 1 14 PM'76 ~ ~ ~ r: ~ ~ epu y egis ar p t ~ ~ ~ _ ~ ~8 r~cE 1~ 325`7f~6 _ ~ - ~ t : - t- 9 - _ - . . _ ~ -f Fr` 4 + ~~.b. . ~"x a~ r-x. t • ~r -a . ~ i ~~3,y.3. ~~"''~~`z~=~c~-~~"~-...~-a.~`s- . ' _