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HomeMy WebLinkAbout0954 ~ . 33E~~i29 ~~r~ i iFtCATE C3~ DEAT~i 11irp~Awew1 ~ ile~~lw ~.~d Q~~u1.f111~11~~ G~.kes ~ fTATt /ll[ NO. ~M~~w~n~r i¦..ini FLORIDA . iv/f. O~ ~dNi IN ~~~~rw~~~ 1~[OIST11A11'~ NO 136 ~t~MA/NNi INR ptC[ASEO-NNW •N?' r'Ma SE1 OA ! d OtA ~+Or~w, ~f~~~ x~ ~ HAAfAD T. P06'II~1N ,1Kal,e , Nlarch 6, 1976 U1C! ~w. ruw. uw~w rNUr, AOE-~H~ wa ~ q~~ ~ • O~TE O~ ~~iM irO•wr. wt. C01MT1f O~ OfAiN ;K. 1 W(M~1 ~~A N~lat I~Y~l1 *r0~ Y~~ ~OY~~ ~M. ~w''+11 1/,1701 ~7b• J.A?~i10 6602 74 1 fiFi. T6~ait ..sr~ c~+ ~•an NOS?rt~l Ot 01~ - ~ r.a w ~nw~. ~w ww~ w«rw~ ~ MKW q~ W MO ~ Ft. Pieroe Yes Ft. Pi~so~ Me~n~Y'ial Hospital TA ~MM ~ r rOr r ~.f 1 M wWl COIlMt~~ MWRHD. NEVE~ MMMEO. 7M~n~1 SpUSI 1 M~w. ~1A YMN ~MM 1 j~~~ cw~.r. ~ w1-M-y~~.I~yp ;e~7n~~[t-o~ wc.., []~~p~ ~j.~~~ Y V~Y~~ N~NMp ~ I~JRO ~ ~ N L"mL~iW i7L'.1v• I~WR~~ ~M~t MCI~M~ 3~U~1 SttUdtr MlWt UfY~I OCCI??~Tip+ ~o~.a ara a.on w.~ www~ +oM w ~wo a ws.~eu a rou~m u•N + M~r M 578-32-1114 -~N' » ~ ~n~~•OM n ~s Ad' . Gen. Offiae . An ~ILM~+C~ M~01~ ~ESIOlMC!-St~/E COUNtt Crtt, tOWM. O~ IOC~TION w.s~ cr. ~~rf ~N Florida St. Iucie F`t. Pierce ~~'~•~Io"• «.p ~w 7805 Hibiscvs Ad. {Aillf~-NAM( ?~yt ~ rM~~ utt M0111E~-MAIO(M HAM! rNS~ rM~~ u1~ Benja~tnn Poehnan I~ucy IGelly 1 - w?lN6 AOO~Eit uneer o~ ~ r•..o . cw. o~ ro.+, ww. trr ~h p~,;~-~ 7~05 I-Libiscus Ad. , Ft. Pi,~~oe, Fl. 33450 , ~ ~ut Olw1M wwi GWSlO ~r, ~[Ntp Or+ir p+E ceuft It~ iNE ~ i.L A? ~?+o kN ai.ew w. •~+.i.+~ N • ~ ~ • ~A ~ ~ -4~ ~T ~ s l _ l , y-~ ' ~ COA~1f10M~ N ~~n ~~~j a~. .M~cw ~~ri ~1l~ ~ .~'C~ - 7 . ~r~~M~t~ ta~f~ tM. ONtfOMNt1 0~= 4_ e` ~1~~1M~ ~0~.•M~M IAM~ ~~~N N~t I\ / 1% / " ~q L, ~L.~Y/- L.c~-Z--' ~L`.~ L.~ ~-L ~A~T ~ OTIrt~ f~GNrKANT CO~I~S+ tO~FOO~~ CO'IM1/~w0 q N~s Wl Nua~ ~o ow~w ~ WTOKt 1r 1I[S n.npf ca.• /J ~ N~ p~ MOI MM~10 ~M N~~MMwr~ twM l~~Y~ Q Y~!~-Lv~_~ ~~-Lf t~~~~~__ ~A M~~•~w «$1~~~~ ~~O+~w, M~. ra~~ NpW INIY~~ OCCYMEO w~w w we m~.~~ ~ w r•n w, w. ~ ~f~oe, ~w ~ M w INAN7 AT M~'O~R N ¦ar. f~~~. ~.c*w•. lOC~110N ~ smn o~ ~ r•..o.. tm o~ ?o..~, a~w ~ ~~Nbq qf M w0/ OMK~ AN.IK ~MKY~1 1b 1M ~ C~RIiKAila1- ~OM~w r~ qY rd~w~ N~ - q~~ I u~ utt Y~ +w/wN Y/~7 OM ~ M/M~ MW M M ~l/1M OC[VMlO ~t 1wf pK~. Ow M wprA Mt AY Wn ~~M M~r I~OY~~ t ~~A. ~w~. p 7~ MN ~M+ue'.m.+„ wr/ I / d a.• ¦.~o~.usee. wr ]i~ ~~C~~H~ NOV ~L - ~ I/ I t( • _ ~ ~j ~ b~ ~1~ LL.~ IM M 10 AM CM1Y1~1 \Yti~ Ct~1NGtq~-M! Al U E~ o« ~n s.a~~ w~ .ow a Ntn. ~ n Mu w,r~ c_ n ~u....~w~. w..w w~...~io~ nr r.ns~n.+w.. w..w~.. - N~w Ot(~MA O~ M MR M M~O nr C~~Ntf~ f~~w~ /-7 , ~ _ ~ M t ! / L ~ ~ `~r M. CE~MiEf- ~ h o~ r~r.a ~ j S WE NeMe o~ mu TT6~T~i~)wE wr ~.T~~ Ib ~ f~ ~ ~ i ' wu~MiG CI '4~ ur~. w ~~•~+o ~•s a rN i tw ~ -t " L! G ~ ~ ' ~Ullµ. UEMAt . lEMOvAI fMEtE~r p~ L~Ewu1Mr-N~w~f tOC t c~^ w _ i ,~~Buri.al Ft. Pierce Cemetexy Ft. Pi~s~ Florida i • 0~-~fE ~ ra~¦. fUNf~AI MOM[- HAiMf ~r+0 ~DMtSS ~ fne~. p~ •+o . u.. m~o~•. s~n~. o~ ~ Fl. 33450 ! Mc~rn~1!,~9,_1976 r HAIRD F'UI~IEItAL H(1`'~ 901 N. 7th St. , F't. Pi~roe. _ 1 v. S. ~612 ~1~iEewt Y~tKi -f+G++~r~E ~ - ~EG~S _ - wrWE ~ v _ o~ tlCf~~lD tOC~11 ~tC~it~~~ ; ioio - ~ - ; ' .tc., Ma c 8 1976 ~ . i ~ , ~ ~ h~rbY cKtifY fhU to b~ • itu~ and tornct oopy of iM lpcet ~ ~ itpl~l~ers ?etord a+ fiie in th~ St. lvcie Cou~ry H~slth ~paA- { m~nt ~t FoA Pi~ru. Florida. ~a~C)C72:7 . (yyernir?y: Not velid unless ra~s~d seal of th~ 51. luci~ ~ j _ . ~ County He~lth O~parMnt~t it affi~~d.) el~~~~~~~ J~,,,a . , ~ ~ ~ ~~c P~~ R ~ ~ ~ ,~11~~~;:~ : ~ N. MIIIER. IN_ D. aLERK ~~t~aU~~ ~~4Rf f(~t` : . ' ~ ? , 3 County ~Ith Offic~r 6 Lncsl Rpistr~r R~CtfRO VER?~tEO~,a~~ - • ~ ~ , - ~ ~ ~G ~ ~t~.c;,~,,r ,l/. ~ ~~,N ~ ~1 ~ ~ : : - - : - , = p,~,~ p~pu~y Loc~l R~o?s+r~r , ; ~ ~yli~ ~ ~ ; n , ; , . • - ~ . ?i . . i i 3 ~ . ~ ~ ~ i ~ F ~ P ~ 's ~ $ • n ~ i n ~ ~ ~ F:~;? FAI;E ~ , j _ ~ ~ ~ ~ ~F ~n. ~ ~ ; . ~ ~