Loading...
HomeMy WebLinkAbout0363 ` ` $~4~ CERTlFICATE OF DEATH + ~ ~ Dep~Nwexl ~1 11h1t~ ~nd Rrl~+Mllldlre Ser.~ke~ 1TATt RIL[ NO. - F L O R ~ D A +r?[. O! ~tlNt ~N ~"~'i°~OiQ~•'~' IItQ1~T11A11'• NO. •i~MANtNT INK ~~E~~O~N~~ a~ ~ St1I OAIE OEAM ~+Ow~r, ear, ~e~~ ~ ut .riKOeOO~ ~Ot . asituaan , J1~MES A. {A~LI.'I'E M31@ ~ 20 1976 RwtE v..rn. wf4q. ~r~~K~N ~wOUw, AGE-I~t~ uwe~ ~ n•~ w.a~ ~ w~ CATE Of NRM ~w~?r. w~. COIK~TY Oi OEAiM ~•c ~ s.eca. ~ wrre.. .,~.e~~ aos. Twn Mw~s .w. •e•~ ~ D~ . Wh].tre s. 75 s~ a • _ L~d~.All R1~,%S C1til, tOwn, Oit tOUi?On OF O~wtH ~.++a ca? ~w~n ?IpS!(Ut pR OTMER NSi1 ~M Ma ~M au.u, cn~ ~mu uo «uw~ ~ VICNT 71\ W MO Vero Beach Yes N Irsdiar~ River Manorial Hospi~a~,, ~ SUfE Of WM ~ b oo+ w v s~.«..~ d112EN Oi MMA~ ~ptJNTl1f MARlIEO, NEVER MARbED, SIlRYIVN('i SI'OYSE ~o ~~n, o~+e aue1M ww ~ r~~,~,.~ tpwnn WIOOvVED. DIV'ORCEO ~ vetrs ~ y.'+,~ Y~VY ~flO/MC~ ~ ia L15A ~ Married ...en oict.s~o ----~y-- ,~.eo w a.r» ~CUniY Ml~ER uSUwt OCCUtwTqH ~u.e a..o a w~a oa.e owwo +os+ a ~Wp p WSfNESS pR M~01lSi~t~T~ oc:w~o w - rouw ~w. ~aN u awe~ ~ . ,,.,~,~.am „256-05-6541 . Polioe Offioer Aetired •/LOlw(~ ~IWY MHN CMr lW1f! S~Rf~ •~wu~ RES10E?~CE-SIAIE~-~ COVNT~ rnr, tow?+, ae touno?+ f _ - ~vtun ns o~ w Flor3da ~NSt. I~cie Ft. Pi~roe - ~W. Y ~w. tA1MtR--NM~E ~~~s~ roae us~ MOTIIER-MADfHNAME ~r9 re~~~ us~ „ Jasnes R. Waite Ellen B. F INfOqMANi-HMIE MA~M(~i A~DRESS Iltq~~ M~.~.~. MO., tMf M Wr+~+. llw1~. trl Eli:zabeth Waite 612 S. 23rd St. Ft. P F ?M~ DfwTH wwS UUSED llf~ {ENfE~ ONLY ONE GUSE IEf [11i tW p~ AJ, ANO kn NtrrlW OMflt ~N~ M~M ~.rs~n wrx _.t ~ -J ~ . ? ti ~ ~ ~ t ~ • N . ~ COMNt10M{, N AM, ~ 7 .r~cr o.v~ n~~ ~o M ~ Z ~ ~"t'Y~l~-G~.• -s aj` t .'~i . Irrl~~~l! C~Yt~ /0/, b~f ~ COwflOIKK! p. ' . 1f~tIMO ~M~ YMHM t~~NO C~YN I~ft C ~ + , ~ ~ • .1 C .J ` 7 ~ARf M O~MER SIGMNKANT CO~'~WT~O~'1S: ~d+d*~s ~OM~MY~'16 p 0t1~IM W~ w0~ YVnO ~O 4Ylf OMM r 1Yf 1 IN M YES ~~n nwo~wea ca~- ~ ~ns o~ wo~ oi ~ouir wuuu.nwo c~ A NO ~Q ~ t?.~,~1~~ ~C~jGt~~ti~id[~R A ~.a+fr, ~w•, re~~ ~ MOw INJU~Y OCCURfED ~ bm~ .uww a u+wn n~ ~•~r ~ w r.n u, n[r i ti~Sop,r~tcK~~Gf, O! tRr011ERMn+EO ~ X~ M . I !a M 2M. ~r±JURY w wORK ?IACE Oi ~N1UfY ~t ror~. ~~~r, snen, r~awr. ~OCwflON ~ snm o~ .a., un o~ ~o~. a~a ~ ~~?wn •~s o~ ~o~ oN.t~ ~wc.,nc. ~sncns. le. !M M! CftiK~CAiiON- .a.~w e~• nu roK+r w. .e•~ u+o wr s~rr wr/wa wuve O~. ~ eo/or w~ .mr ww Otwm OCCUMEO •t ae rute w r~ ?MTIKI~N: . ' ~O rO~.~M M~ tlY ~OO~ i11l~ q~~ ~wW~1 C~p, ~M, ~ Mf YM ~~nlNOtO irt M r~ a~+O+r~eoG. M t~~ oeu•uo nor tl~ tli ft1 }N P~ M. to w! c~w~s~ s~~M. Cfii1'1U~IOH-rMEDICAI f~ANYNER OR CO~ONER~ o« n.~ usH p*~e wpw.or ot•n. ~ ~M! NCtMwt rry ~W.~OUwCtO Of~O lr~rn~•~r:r+ O~ ~M WOf u~D/O~ iwt .wveatl:~lpH. u. r. Wwa.OM, rdaM o~s hA~ MDY~ [l~~~ oilui~f~ O.~ Ml wM ~MO OYt b M C~1Nl~U 1~~~1Y ` 2)~ M JD _ M. i CFRiif+ER-NAMSrr..ro~•~n.u-- ~ K.NA Ot~u~o~nM A IC~Oa~Orm.o.~,1W~ ' fi00SY.1\.NG HOOSHAtA.'~D- ~ r' 1.~~ M. D. n~ 5-2t-19~~,~ 411WG AUOYf~S--l!/l//KR 2SOO~ .P t'1iM~~ d~ r ~ li~ ~ tt~R t~~ L/ ~WIAI. CREMATIpN. R[MOVAI CEMEf[Rt Ui CRfMAIORY-NM~E IOCAiION ~ t~n O~ torM tt.h ~ srrc,~ ~ r1Cl~ FlUL~ :aRHIIORTdl-BL1Y'ldl t'?~•__~~.P.LOB_~C'~' - tw 0~7E ~rw•~, o~•, n.~~ lUNERAI MOME-ftiAME ~ro0 ~Dpt[SS • s+~en o~ ~ r.• .w., u+~ w rowr, s~.n. en ~ ` t 20, 1976 BAIRD F~INE'RAL HC~4EE 901 N. ?th 5. 2? itAt.i~t UEC!M-SrGru W[ / RfC,tSf` - SiGtu~tURf OAIt Qt[~Y[D t~ ~OCAI lEG~StM} aPV. ~~,e l'~c t' Lc!-'z'~' t c r.? -02 f~ "I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE LOCAL REGISTRAR'S RECORD ON FILE IN THE INDIAN RIVER COUNTY NEALTH ; DEPARTMENT AT VERO BEACH, FLORIDA." ~ ; TYIS IS NOT VALID UNLESS THE RAISED SEAL OF THE INDIAI~' RIVER COUNTY HEALTH DEPARTMENT IS AFFIXED. , ~ ` ~ r,J,. EQ , r~ I ` 0 AM ~OUN~YUF~A. - • ~~,`~C?i~ P~~1N?6 T ~ 1 `~C~~ : . ~ ~~K ~~,sC~?T CUa „ R RAR ; s " ' ~~~'~~YC~'F~f~ ' ~ ~ ~ ~ a t ~y ~'~6 /~7 , ~ - ~ ~ , J~ Z~ ~Z ~r- .e C~. ~.2 ~ ' - 1 ~ DLPUTY REGISTRAR . 33844~3 . ~ i ~ ~ r eac~ ~ ~ = r ~ ~ w ~ Y. ~ - _ s