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HomeMy WebLinkAbout0366 , ~ ~ . ~f,~ . _ : s--ys~,~: _ . - - . . _ . _ . , . CERTIFICATE OF DEATH I~rtwer~ d Ikdd~ ~d RcL~bik1~11w J'erylce~ lTATt ?ILR Ii0. ir.~wc~i~~.TM FLO$IDA • r•+~ • tn'E.~ Oi ~RINI IM w+r•~r.w~awawe N[OIiT11AR'! NO I f)t~~ ) ~ if N~MA/t1A INK ~p_?rAMf ~N?~ ~ !l OAiE ~.an., r~~~~ ~ g~ , ' • ~ ~ ' ~ . l9 tuGE •ww. .aaw. •.rau.w wwr. ~GE-ua u..a~ ~ n.~ wa~ ~ s O~1t Of MtiM ~.~w~w. COtR1tY O? OEw1M nt. , sMtrr ~ ww•~ ~ n~a ~ rof. ~.n +oati a..~ rw ~ ~ . e Y ~ ~OC . z1 190 5 ' . C~t~r, TOw11. O~ t OE~M auw cn~ u.n~ MOSMfAI O! OMN ~p+- ua w uura. cn~ ~~u ws .ww~ ~ ~ sncw. ni o~ uo . . ~ ~ e$ M Yt S . ~O?~ tU?TE WtA1 ~ r»o~ w v.t.•., •~••e Q11Ztf1 Of wNAT COUNtR1f MAMIlC. t~vER MA~IMEO. SuRVN S~OYSE ~ r.~w. one .M~e. ww ~ coww~ ~ • W~OOMRO. ~ vtc+s ~ ~,r.,.~ . GeoY ' . , » • ' I~M~e T3rQn1t~~--- .Kn wa.us SOCUt SE txw~ER uwn? OCCU?~t~0a ~one arn a w.a ow~ c~n.w ••oa a t1~0 Oi WSr~ESS Ot wWiSratr ~ ~nl~. r Oh~M vionr4 uw. evw r rwew ~ `~fIqM~1.6M / „S 1~ 1~ , s~ ~ •~~0~` eES~ot~-sr~~ touwn mr, T at iou?noa ~ ~ ,fMtMr vq o~ wo W y~ o ~ uC: ~e. i~tMER-N~+rE ~att .rwe uu MOtNER~~uiDEN wu ~wa~ w~ ~ acK u e i' Yo e ~~ypRMAM-wiwE ~ w?LING /?DO~ESt ~iwu w~.r~. Mo., cm a+o..n. u.a. ir~ M '±a t F . 7~ ' W W r~urt ' otwn+ wws twustu nr: (trm~ aar oa[ uust rtt ~r+[ rot NL M1L ~v+o hN .awe. o»sa ww q wrew~ ' IU N w~ ~ J lt ~r N 3 ns~Y ca.ar~ori. ~r ..n, /j ~ ~ .¦~c« owe ~~se w ~ M1) ~gfisat !.~lOC - ....ewn c.~u ~w. w~ w.-o..s . ca.xwe.~ce a: sr•nrs rw vM~a- ~...a c.~ w~ kl N?tT ¦ OilK! S1GN1fIGW1 CONDRIONS: cowwan w.~wawa w ww kn ~+o~ ru • a urw c~A. r. ~.n ~.r MROKr If ~ES .ea uwa¦os co~ ~as a.a~ xnm.row c~w • 6a L.~ - • IVCJC ~L. ~ V/c~ n~~ 1A iw ~rt. ~+wm. w., se•~~ MOw IWUtY OCtYtRE~ ~ e ~ w.Me a uuun M. ~.n ~ o~ ~.n K wr Ot NOElE~1u~~W ' . ~ ~ 1~t. M. 7M WAq1/ wT w011R KA~CE Of NJIRr.~ ror. ~np~. ~.c+on. IOGT~ON ~ s~un o~ a.r.~. .w_. cm w w~. u.R ~ _ - 1 fMtlti ~tf O~ MOI OAK! ~1~6., ~K. ~ fRCMt 1 . • 7w • 7M- „1 CE~G?TION- .ora ~+s ~e~ roNr e~r rw ur uu wr rr/rw ~uw or ~ Me/01~+~O~R~ Otwn~ OCCVUEO re n~te. or M N1~SK1~M: rOM1w C~t ~!Y ~00~ w~fN N~ ~MOMt N1l. ~.4. /0 1! MY ' , .~».o;.~• - 5- 7'~ T°~. - t o - ~6 n, N - /o • ~1b ~ ~ ~ 9 o : ~ _ ..«.u...o. • CERT~IG?TION-MEDICAI EYAMf~Ef Ot CO~O~~f: aa sN 4s~s w+Me ww a M..~ me wuoen .~s woww.cw oe.e es..w~.w or re ww u+elw u~ rr.esnwnow. w r~ ws.wr. rdww wr a.~ wr~ . Ot~M OUYrl~ O~ M! O~~! u~O W! q t~! UYflW t~~N~ . M~ / O' ~ _ _ _ CpTIfE!-fiAMf mN O~ Kwn - ~.ON~w. M*. ~Nll n. _ A b eNt I s• . if 76 ~D0~ESS-C~j 1FE~ s~rer w ~~.e. wo. c~n w w.u sw ar " tH ~ bE'T`t 1 JP ~.t C ~ CT '~p _ T+ r.~ ~ W~w. C1E~u?llOf+. REMO~n?l tER1t Ot t~Edu?TORr-wlwE tOC~np~ urr w~w~+ ww ~ f~u~ ~ C ~ 2y !M. DwTE ~.~w~. e.r, +w~ fU R~t NOr+E-tu~E ruO ~DOfESS ~ stuo o~ u.~. ro.. urr w ro+~+~. u~n, nr ~ Pr: t 3 r r. s. K 12 - * ~ocx ~aarw R~v.19?0 Zp - ~ al~~~.- ~ INt t~ ~ 7'~ ~I - . . I~Y C~tTIFY T8B ABOVB TO BB A TRUE AIiD CORRF.(.T COPY OF THS RECORD ON FILB IN li .`REGISTRAR'S OFFICE IN THB BRSV ~ ARD COUNTY HEALTH DEeART1~TP ~ ~(Not~ va~id s~.,~.he seal of the Brevard County Health Department is affixed~ ) ~J ~i~~•?a~`+ r`~ i~ 1 ' ~ 1~ . ~ . . ~~.~e . t ~ " , ' • Y ~ .:y~•~ ~ ~ ~ ' ~ ~ r ~ - { , ; f."~ - ~"1''Y: . Local Registr ~ - 3 ` ~ . ..MA~_•~ ~ . , . ? Date • . . ~4 i Deputy ,Regie ar - . ' f , ~ . ~ ; out~tr CIEIIR~C ACUIT C~~t RECORO VERIFlEO s~ ~ a ~oeM t soor 2~ rhr,t 3~ 3~4462 _ -