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HomeMy WebLinkAbout0066 _ - ! - - - - - . - _ _ _ ~2:~y55 ~ ~ - ~ CERTfFICAT~ OF OEATH Drpulwewl oI ~ Ir.+ItF~ a.,a ~~t~t;~.u.~~ a~...~.Y. F L O R I D A ~*w~E FiLE No. UYLVqV IIF1i.il1 TY~F, Oi ?R~HT !H ~K~'"'~iQ'~n'T~° REGISTRAR'S ?i0. ?J'~ . 122MAlt2NT INK DfCEwSfO-N~w[ SEA D~TE Of UEAM S[[ MJd41t00t FOt n~?~ ~ao.~ ..u ~ ro..a.., o.~, ~w ~ unuaars , Arth~r Richard :.elseth,, DZale 4, June 28, 1973 RACE ~+•+n. wtaw. ~+~uc.n wauw, ~GF-..a* ~~-o~. ~+~.e u~oe~ ~ o.. OwTE OF i~sTM ~ro~.-~, w~. COtJNiY OF OEwTn ~rc. . i+ecur: ! u~two.r ~n.~s~ ~o~ w.s . wwas rw.~ ~tu ~ ~ . ttiTl~ite 1,~ 75 ' is, ; ~ar 25,1897 St. Lucie ~•,v9 CtSY', 70WN. OR ?BCATION Of OfA7ti T µs.o~ c~n .~..m MpSMT~I OR OThER hSi~TUt10N-NAME ~Y Mpt 1M l~Tw(~. 4111~ ?TK~1 ~wp ..w.~u ~ r ,..~u. o. ..,1 n Ft. Pierce \o Rt o 2;sox 1154 STAfE Of l.R7T/ ~ w..ot ~w , r..~t:GT12FN Of WnAT CAthiill MARRIEO, NfVEA ~1.AiCED, ~SWYiVRKs S!'ONSE ~u .rm, aM .u~Gw w.w ti tow.n. I tti'tOOwED. D;v6RCE0 . sreun ~ -~~.•••»M. . r lorida ~~Sn ~:arriec3 La.ura Shiland t ~~en a~ce,a~o S~y~ ~CUR:~Y NJWER ~ USU~1l OCN?A71Oti :Grt ....o o~ .+wa oo.~i ow~.w ..ou a KWp pf ~USwESS Ot wOUStlr ~ ..:fa. d W.tw . ~ ::_~,,...o = ti3 18 3155 !'.b.....~ ~ ~rower Citrus k.o., '»'f~"'- RES.~f~+CE-St4if COUMY wS~M C~n ~r.~ S~REET wNC MIWkt ~ jG7T. TOwN. O! IOCwTIpn I ~YICMt ~f~ Oa w0 :~2orida ~,~,Sto Lucie !,krt. Pierce Yes 1018 So 8th St. fwtn(q-?:~E ~,~sT ~,oo,~ us~ MOTMfR-MAIOEN NMrE hur row~ w+ ' ' „ John ~Ielseth Agatha Grue inl00.wu~hT-.-H.u~ef r~Aru+G wDG2ESS ~HHf70~ ~.~A. MO.. [m w ro.», at.n. ir~ ~ Laura S. i-Ielseth 1018 So 8th St. Ft. Piezce, Fla. lwRT L pEATH WAS CM/SE0 /Y: ifn7ft Gtt1l ONi G~SE ?E! iWE fOt (o?. (0~ AND l~l: " ~ ~rr~oa~r.n ..+'+~v.~ ut.+u~ o.+s~t ..u oe•r¦ 11. . ~..roun u~a ~ ~~3 DOA at emer nc room FPMH histo of leuk ~ . . , o«u~~ , o. - :Dwo~t~Jti3. .w~. .r~~c~ c..~ use ro ~ f0i ~ r+eD..M Uust ,n. ~ a.e ~O. Oa .s .[o+seO~.e+Ct p- - YI~T~r1G in1 JtiCI~• ~ ~ ~ ' ' ~~ING (~Y3~ \~1( i i iA[T N 07Nft SKshV~CwNt COH~ITpHS. co..ancr.s iaa¦.~~r,..~ rp p~.rn wr .or ~~..no ~o c.use ~m.. r.~r ~ wi ~aS~ tF YES ~l~e riwo~MGy :ow- ~n~ ~ u oi IM~ ~TlWMMiG U431 No ;~M ~~meaSl! A:Ct:~fnT, StiiC~DE q~DATE tsi W1UR7 , w..r.. ~e.~ ~ ~t~OliR ~ HOw INJUR• OCCURtfO i wT~e wrwt p~+~un ~w ..o ~ a r.n .n. u~ . ~ `t+++~C..~E: 04 Nh,~kTEW~t+ED . fiawipl 1 j . i?r,; ~70~ M I~ tWUtr AT WOtK 1lACE Oi W1W1Y wa+e. aru~4 r.e~~., IOCATiON ~ s~~~~t W~.~.~. .ro.. em O~ tw~... si•n ~ ~ } ~ S~t4n ~!1 O~ r~SC :`prK! MDG .~K. ~ S?lC~n' ~ ~ :C~ f?df ~f ~ CtiiRiCAt10N- .a.*w o.r rw l .o..rw a.~ iw ~~^~D 41t LM~ ww/wU Y1'/! OM ~ ao/oro .o+ v~~vr na 0lwin O(fu~tp •t tre ?u~ce, o.: tw . ~ ?MTSK~nN: , ~O.~tw O~~ ~lV ~00~ Ytl~ OE~M. IWYiI i7 o.n, uw io sr ~ear ~ , ,..,~o~o r~~ \ever TO did ~c w ~ Ta aetuu~ ~,a~ '~.iti ~'J4 tt1 T.~ M t0 dl CausIU1 ir,~'tD. ~ f CfRT:F~GTqta-iwE~~CwI El/w~NES O~t CO~TONEQ~. a. r.~a a.~.s w r.a „o„~ w w.a e.e weea.~ r~y rwwo~,..eto oa+o t~ud~t~0~. d t+f q~r ~aD/O~ fwt wv~N~W~~Ow, w rn O/wW~+, i rO~Sw Wt ~t~~ ~y~ ~ J 4m~F OCCwVtJ Oti M DATt ~MD Ofl! W tM U~H.1~ ST~ttD. . M'7n L ~1~ ~~b$ n~ Vy~ M . L~ ~ CEYIIfIfQ-ivM~E .mi o~ nwr, ScG+rwTU oewu o~ r~ru ' aATE S~G~+EG ~~a. w., •w~ Hooshan 1Cadivar D. ~~x 7-3-73 ww0.' C tiF' . sra[~ w~.~.o. r+o. - ' w~.,. ~r..e t.r S r~ '"`'Y(~~or~? St. Fo ~ e Fl 334 WAiAI. CREMATiOH. REMOVAL ICEMETERr OR GRfMATORY-Hw+NE tOUTqrt un « w~+~. s*.n ~ 1 YKM~ ~ ~ Burial Vi:-cir.g Cezetery ~ ,k Fte Pierc.e, Flori~3a DwTF ~..o»+. w., .i.~ ~ N[:i~U1 HOiwF-NMMf AND FSS ~ sn~a o~ ~.~.o. w.. cm u torw i~ri. :~r ~ ;y ,;une 30t~?, 1373 ,~Yates ~unera~ :io:~e Znc PO Box7~l7 'r't. Piezce, Fla. Y. S. f612 ~u~t SC10R- rty~F rtEG~ -S+Gre.enuE . o~n ~te[~vEO ~r ?oeu aasrw • a.v.iylo l;, ,w Julv 3, 2973 t h;,rr?.'~y cartify thls to be a trw and corrrct o~~r t,t t~f0 Lflqt FIIED xhD ~_CJi~0E0 Rt~,istn~ls rewrd on file ln tho St. Lvc3o Courtty ye;;};}~ p~~,.y} st t~~~~ ~OUMT11 fU. ~nt at E~ort Picroe. Fbrltla. RUCEF. =J~tRAS (tFlnming: iVot vaiid unloss nissd sc,a{ ~f tttia (rts~i0 aFCGRF YE~~F EC ~OURT : ~ , COU:1ty HOatf~l ~Bp~ffi'sM! ~i b~X:~ ' r~ -~?/i,~,C~_ _ . ~M ~l ~Q 14 ~ ~b ~ ' :rt ~ . Mi~cst, : - ~ - 1!~ D. - : ~ . T , ~#3Cjtti Q~iG."i ~t ~.Lt' T~1f ~ ~ ~I.tft ~ . • r . y~ai - ~,;;r-s"+`~~,' . - ~ _ 7 3 • ~+a,,n _ ~ ~ ,~.5 1r0~ . K: ~ D~~usy Looc! R:,~~ssr.J i 1 ~Y l'~ F ~i PJIGE ~