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HomeMy WebLinkAbout0498 il ~ ' ~ ~ . ; i ~ f ~ 333 z~ 1 ~ ; CERTI['ICATE 4F UEATH ' /TATR /IL[ NO-____ Ik~rH~weNl ~1 I(~~h6 •n.l R~h.l•~L~~u.~ Vn1u~ F~ O~ I ll~ I~r7~+iv ~N ln ~t ~n r~ t O~ ?~~NI IH ~.ww~o~.. ~~.r....• • Af C.I}t1RAQ'S HQ ?1\NI.It!NT INK DlllAS[0-H4w! ' a~f' Sf~ OAIt C/ OEw1M ~ru..rw. ui N:r~w+a. ~o~ ?::ti:ZI~ CI.QHIA !i~:'IDi::i: 0;: ~'r;:.1le /~u'u~t 1..~ 1;., wsr~uan , t - i . ' t~CE n~. ~w~o. ~wuc.r INOt~M,__ A~lE - 1~f1 o..c~~ ~.e.~ o..: u~ e~_ ri U~IE Of ~uM ~.a.w.. e~~. COU?~Ir Of 0(~1H ~R ~ f~~cw.~ ~~nrs.r ~q~~t~ wf w.f ~.ou~f~ rw ~ n•~~ ~ ~ ` 1 Q 7 ~7 :.`L. ~Ob~c°~'.'~. ~'..!ll}.C t~ i~~ N f~ j : r• ~R~f. ~OM(N. O! LCJ~AII~N 01 O~~iH w1~0~ tM~ ~~a~~l N~Sh111 ~f ~~Hl1 ?~1117u110N-NAMf 1~~ wQi ~M ~1~w~~. GN~ SIMI~ MV~JI~ 1 s.an. .n w •.o - /1. ~ ~ •'~i l ..::ood Yr.s P.oct~r^ FicsFit~.l . ^ ' ~ • _ ` - - - - • SIATF O% t~RM ~ ro~ u s• G~~IEN Ot wMAT COIR~TRY irALRIED NtYER awRatEQ ~SWYIV'M1G S~OUSE ~u rni, nnt +.w. ~+~w i - _ ~o~~u.~ w~ooWEO.o~vo•ceo~..~~~.~ Donald i-'.cnderso~~ .~.1• u~u.~Nt~e~a , i'~...~aciit~:~et~..S ? <<~v~~• `t• `~~'j^j ..e~e oer~.sre ~~u ~~Uhlr M/WtR ~ ~ USU~I OCCU?~t~ .a.t ~wo Or rw~ oy.~ w~~..f, rof~ d K4W O~ WSWESS Of INOUSit~ ~,.~o a.n. eccv~~eo w L ru„~+e un. n~" ~lhilC / ~..i,~~~...e~.. c~+t i~ n~ ~~~.G'Zl`a~.9 ~y .'~iC!~1.~'itG~~ Ct~ ~.!1~'.^.~.: :':C:'T`~.~.^~ ."i - ~es,ce~a ~~roa ~ wpq ~m i~..n~ STt[ET IWO HYM1E~ •e+~faw~+ ttSWENCE-S?~if ~OUNIY G1ir, TOWN. OR IOCAiIp~+ ~v~cur .~s o~ •w, ~ TZC~'i`:~~~ :`r0:"''_"~ ? ~u t:01~ .'1:00~ i~~ ~i~. 7.L~O T......~.~i.;!" ~'Tt`^a IAMER-NAM[ ..wou ~f~ MOIN[~-1WIDEN N41NE rua• .•oa~ uu ~cor.^c • louis Lavir~r.c ~ l.rno~a ~ut~i~ ~s • INf~RMwtU-r+~E Mw4u~G wDt•RE55 ~+•.en m~ r o.+o. u~. M ~0~~, SUry. Ir~ Don~:ld ~:er.~?r.r~on, ~r. ?1'0 l??rdin~~ :t. :'.a~?~:e;ec3, ='lorida ?ARf 1 Q(AiH WAS CA45ED 6Y Et+lEf GNIi OI:i UUSE lwf 1C- ~~~~~~w { fb). ~~~D ~c)i iutrt~w orf~r :a.•- Q u..ao~•n c~vu ~ lel~t~u-~ t?C~- , f l~~ \ . . co..vou~~.c~ COwD~t.Ouf. •r~ ~ 4~haJ.tiv~ . ..~c. a.., ~A, e~.•,-t.a~....,~w..C ~ - - ~..w~.r~ i.we ,o~- ow` ~o. a.s ~ e`o»iiow•K~ w ~1~t~NG lw~ YMO~~- t1~.~G C~Y1! ~~1~ . ~ t+_.. (cl ~ . ?wRT p OTI/[t SKsNUKANT CONO~SIO~~S' [OMWhpM~ COM~\NYI~NC 1p Q~~M Wi nOl QN~fC f0 C~Vf~ 41V~M .ur ~~o~ w11f0?Sr ~i vE5 ~n~ n..e~ncs tc- 1~~f ~f DI LO~~lS ~M D~1~~~IM.MG (~r!~ O~ Ol~~+~ i ~ _ • p.el.-!'ri !'u~[~ii, SuK~Of OR ~O~I~CTf INIURY ~~O~.rw, yr, ~tu~ NOUR ~HOW ItJIURr OCCCRt[O ~~••q~ ••~~w~ W u.~uts ~•n . w ~~~i etr ?GM~UOE. Qf U~+GftEU+u~tD . ~;.°"'ti' I ~'0 }':'0 ~10• M Ml I~f1U~`I A1 N'GF~ ?t~CE Of ~N:var ww. r.¦.,, s~nn, ~.oa•. IOC~i~O?~ ~ sma o~ e..o , cm o+ ro..., s~.n ~ i ara•n .~s o. ~o~wnce ~~o;, . ~+c ~ s~eon ~ 1 10~ t ~a ~ l~+ - Ctii~fK~~p?~- w~.... o.. ~ ..o~+m o.. i...o us~ s,~ •.e~ .~~.e o.. auiaw ..o~ n.e ot.tr occui~to •..t r:^ce e~ /NiStCuN ` ` ~ jp . ~ ~ ~ ra.~. o.. .t.~ soo. .~*t~ oe•n. ~..cu.. o.n ..t. w-.•t wf- .•*~.e~nr.r l ~ ~y ~~j~ ~1~• 18~1~/11 ~ `J ~:1~DA o'..a~o-.exr c.• !1• c~u.s~o •~c+ ~J / / y~Jlf ~71~ J / Z~~ 1q r~o ueu f~ Y.•t~ ~CE*il?KA116N-- Nt1KAl E~Aw~~rvFt CR CGQON(R r..~ ~.s~t a n~e .oYe o~ ot•M i~~ o~c~w~+ ~.s ?~o..a...c~o o~.o ~ ~....r.•n.~ c. n.t w~o. ...a o~ ,..e ~...er....'o.. or...ro~+. ~ ra+rw o•• .l.~ ~o~~ • J o~.,~ oee~oeo o-. +.e .•.o ow .o c.ust,t, )~~typ - M . ~n CEtf~~~ft- r~wME ~t~ry G~ r~~..tr ~ 7 SKsNI~SU f_~_ ~ Hf O~ t~t~f ~wTf _~Gr+EO D~• rn ~~.5 << _ . je ~ . Tt ~r~. Y~~-.~ l's~ ~t'~-~-~t !~i l~ ~ µwqwG OGiE55-CEe'rs,~o tiuee+oi c»o c~+~ o~ •a»~ s•. ~ )1e .f 1 S ~~~.-~1 tL..~.c-~.~t~ f~L n ~~7/CD ~U2Ul. CS(MA/IQN. REMOVAI ~CF.~EtEA~ OR CRfMAIOR~-n~~vf tOl~i~C?~ ~.n c~ •e~» e•.,~ r ~ ~ % ~ t.ean . ` ~jiri~l ~estlazm i•:e;r.orial ~arden9,~, ~roHard County crida , ~-+ai.1rL.~ Cat~ - o.. .u.. - . _ tVroFP~I MOw~E-.+iMf ,:nn;fSS f»en o~ ~o .o n.. o~ ro... s•..~ Lt V----- _ f IN ,:~~..~it 21~ 1~1~~1~ ~Ik' ll~y, ~..•~~v~~.c.. S!'~:+1 .~~1~^..e~~v~ i~~ i:~1~~K^n~~~l.. .~n~i ,~i ~E17 ~U+ft~t O~~ECTOo-SiLN~r E j~ - ~ RfGiSItAR-sr:~.a'iraf . O~'! ~fCt.tlD iQ~~a a! • - /~1 /r. y 4.)~~.• ~ Rtv. 197•. :S1 1: ~l~' , f'~~ j,y •~~t'L'~ ~7~e ~ Y ~ - - i - . ` ~ r i ~ 1 ~ ~ t . cLx•rtr•ii:j, cur~ . s ~ i I~ereby. ccrti~Ey,.tl1C '•above to lse n true nn~i carrect copy vt Che Local ItegisCrar's ~ rccord ~ott::~ile~~in`Glye'lirtoWard (:ouney llealth llcparL-ment- at Fort l~uderdale, Florida. • ! ~ ~ ` . _ ' ~ (Warnicts-Not vnlid.-unliae•.raised eeal of tLe Broward County ![ealtti Dept. is affixed.) . ~ ~ ~ / ~ ! ~ sj ' ~ ga ` - ~ ~ '-.r ' r v (/vj ~ ?'!l ' ~'~=CL.! 3 , - • ~ _ ou~ en L-T~F~j~er au Loca1 ttegistrar ~ • _'S_~,7>76.,-r.- ~ - ~ . L.. , . . , ~ ll~f?~C .1..1~f~' 1. p. ~ . - . ~ epu -y ca cbiat ur , ~ ~ • ~ ~ f,~ % - ~ 3 A ; r s ; ~ . - ~v ~„~n~tt~..~aN ~ a ~ . . ,_•.[Y AT lA`h FiLEU A+~:~ KECOROEO ~ ~ 'MNERCIAL gT. ST. tUC1E COtlNtr FL~, ` < fiOCEr rvi~~AS ' ~ - ' }96 . C~ERI. C~aGU1T COUNT ~ ~'~CH. FLbR1OA REC~°•~ v~r~.-IFD ~ ~ ~~i2 ~ D3437 ~ ~ ~ ~ ~ ~ ! a 33Si4 ~i ' : ~ ~ ~ 4` _ ~ . _ ~ _ -