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HomeMy WebLinkAbout0855 CERTIFICATE OF DEATH 33(1,,;;~ ~ ~ D~p«+.Kw~ .t Ilr.hl~ n.~ R~Ii.1.~tx.N.~ S~..ke. frwTS r~Lt No. ~MV~wv ~sa~.Yu F L O R I D A tY?f, O~ ?HfiT fN wM~~~R~~wp li[OISTRAR•• N4. NlMAlNNT INII ~~~p_Ny~ rMf~ •,~t ?~sr SEX OATE Oi DEAM ~ roxte. ~s, ~~w~ t SEE MINI00~ i6~ .sn~c~a~ G. CLARK Ma1e ~ ~ 3anua 24 1976 ~AtE vn+e~. neow. ~re~~uw rwuw. AGE-wt ~wo~~ ~ n~~ wwa ~ w~ DATE O/ NRf11 ~+a~w. Nr. C01Mtr d OEATN ~u. i aacw~ ~ M~TMat 1~Y~N YO1. Y/~ ~s .w~. ~w ~ ~ :~thi te .73 ~ ~ ~Feb. 16 1976 Monroe cm. toww. w?o`urww ot~rn c.. .~s MOSMM OR 0:1~ ~'KI~M - 1~1 M01 M ft1W\, o«. •n.a ~ ; ~9 a n. t~arathon no Fishern~en's Nos ital S1AlE Of W1M ~ r No~ w r.~.~., K.ri Gi1Z@! Oi MIliAt C01MT~~ MAtl1ED. NFVER MAWED, SURVIVNG S1~OUSE ~r rw, oM .M~e« .wre ~ ~,~.,„.e..~~ ~ y~w York U.S.A. N~~ar~~~`~~ Mildr~d Ar us ..+e.~ au.LS SECWIir MwVE~ . USU/LL OCOUrAt10N ia.e a.a a«oa eaN eu~ra roa a RMIO O~ MlSMiES3 Of M1DllStR`I t~rlD • Ol~M . 'MO~tllb tM~~ MfM N MMIY 1 ~ O!(Y~NO M ~~1t1^^~°". 275-10-1726 Salesman Ti res •ausuo.~. RE51DE~aCE-SI~tE COUNTT CRY. TOMM. OR IOCAiION ws~W cwe iras S/~E[T AND NUM~ER IfHCN! 1t~ W MOI ~a ~ii chi aan Pl ai n~~el l unk. l 1555 Fords Poi nt Or. fAtMER-H~wE aa~ rwat us~ MOIMER-MAIOEN NAME rrft ww~t uw ,s E~~ Clark Charlotte Pike 1?MORMA?1i-NAME AM\R~Cs AOORESS uutn W~.c~. r0., cm p W~. si~M. frl FSrs . Mi 1 dred Cl ark " ,,,11555 Fords Poi nt Dri ve,Pl ai nwel l, Mi chi gan49080 rw~r i. awn~ w~s uusEO ~r~ (EMER 014Y d~ GUSf IEf tlif fOR hL (el. AI~O kN .n: u~ :...i w~ ~ N wrew cw ; ~ ~•1 . ~ Ct ~ ' ~ ~ ~o..e,~,o.... , .~E'v~•r~ / r • r - ~ ~ ~.s I` vN~cw ow.~ nat ro ( 1 ~rMeo~~4 e~nf~ ro~, N1~ M. p~~ ~~O+~ffQYf p~ { 11~~IN0 TM~ YN~~!- 1~~N0 C~YY lNt . ~ _ ~ MRi 11 Ot11Et SKiN1iK~WT L01~Wt10NS~ ta~wno.a to.wwunw w w~n. ~v~ ..o~ Nune ~o u~w onrrN M. ru~ ~ a~ ' ~~Y Y ~f5 ~~~r r~..?~ro~ coN- ~ ns o~ ..o~ , waao iM wu~.uuuu~o twrr a ou~w ~ ~w ~w NUrt+GOE~ OR~tMO~It~W~~ ~ OA ~ ra~+M. Mr, rl~~ ~ NOUR MOW INIUt~ OCCUlREG ~ uaea ~u+vw or ~wwe~ ~M ra~t ~ p rwn w. wer ~ .,'«'b1 - ~ L~ M. ZY. INIUR~ Ai WORK ?IACE Of NlUfr.~ row. r~~r. ~nne. r~non. IOCAi1dN ~~n~n w~ r.~. Mo., e~rr o~ rw.u. i~.w ~ 1lNC~/~ ~ff W MOI OMK~ M06.~K IVKIRi~- 7A ! !M * CERfIf1UT10N- ~4nw O~~ RM rOrrM O~r ~~y ~w0 4St Ywr ww/wN M1~f OM ~ pO/qpra~ vMr M OEAtN OCCYf~EO ~r wM ?uC1, O~ wy /N1f1C1AN: rO.,~w O~~ rt.t ~00~ ~~tl~ Ola1w. ~poy~~ o~w. ...e. q~w MSt ~~rn..ors me ` TO l~I~ o.rwe cw ~iu u i:ao r. e.~..~o ,.o.. /-~3 7 ~ zy 76 / ~ y 7~ D i D CE~Ti~1G7qlI-iwEDKAI Ex~wM~E~ OR COROHERr o.. nr uws a ar MOV~ W O~~M fIN MC~OfNI MU M~WMl~ W~O ~a~u.w•tv~ d wif ~oo~ u+e/W n~f ~e~rHt~Wnp.. w~ r~ p~wOr, rd+~M ~ o~~ r~u rov~ o..n~ «cw.w w..e e.~ .n. oa w n. nY+.a, ...ae. m / .7Y. . 76 ~t. tr. CERTIf1E!- ~i+n w~wn S1G1iA .~!('.wLp/ qne D'ATE 51C,NE0 ~+w~a, s.., •eul - .~~sre's LC ~ F.~s i- i4. ~ ~ ~ ~_<< - r- < ~ - 7~ srrn o~ ~.r •.a c.-ri s+.a ~a MAt111('i ADD~ESS-CffhilfR ~ - " . ?y //O~ O M'~`/~JFiSIS Hi: /f~/~'/l7iNc3,~,~ ' ~ 3~"~~ `e. t ~UR1AL. CREINAiiON. ~EMOwAI EIMEiER11 OR CREMATORII-N IOCAt1QN... :.5.: .Vn O~ fa~r s~.n ~ ~ wt~Ml • ~w Removal Unobtai nabl e .~a~ry°Coimty, ~N chi gan 1 ~ OATE ~ ro..n.. Mr. na~ FUNEtA1 NOME-WM~E A1+D AODR[SS snrn w~.r.~ w0. 'twr w?awi sut nr ~ - - ~'~~a Ve i e un~ral Home-' ~~`Box ~/'1 ~ia'r~thfKi Fl ori d~~ 33050 - r• 5. ~612 owECt - RECasTw- ~rur[ ' - o~n ~~~eo ~t au~ na~s~u. R~v.1970 ~ 1 • ~~7 tM ! rliirl ~ L t fN • ~ ~ . i . - . CERTIFIED COPY . ' < ; . ,i • I hereby certify the above to be a true and correc~ ,C,opj~~'nf the ._v~_~E~ Local Registrar's record on ffle in the Monroe County Ilealth ~~~~~=_~•~'=N~r Fu. Department aC Key West, Florida. ` ` ' aa5 f _ ::-:,rr~c~ : (`iARNYNG: Not valid unlese Yaised seal of the Monroe County ~ ~~R 3 Heslth Department ie affixed.) . L Z 41PM'16 ' Date ~Z~~•[6i. 9 l ~lr ~ ] . l~i~~ )t~a7 , ~ ~ ~ ~ 8~Q Re istrar ~ ' , ,tt ~ ~r ~ , ~ ~ ~ , r . _.r - - _~~t~-~~ ~ r-,~.~ ~u;~~ . . ~ z~