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HomeMy WebLinkAbout0973 . - . ~ - ~ ,.-~:vu~rl l.OUNTY.t-It~ALTH UEPARTMENT V~ ~ 1 ~OS E. KENNEpY elr0. , ~.0. o0x 17~1 T.~LE?MONE -E2~-~~i~l- TAMPA. Ft.ORIDA ~3801 272-639G"` ~ 3~E~~2(I~~ ~ ~ CERTIFICATE OF DEATH - ~ , . a ii lTATt ~~L~ ~~'.:i:i~ 3w.i :~~i~r:rii wii~r .f'tYj~M IM~1~N~.\IMIM\I111 FLORIDA ~ ~3"~9~- ~r r~ vt ~r•r "r•• °•'~"s R[OISTIIAR•• NO ' •NiN~ INK ~ ,~~.Ixi 1Q1 oeCe~~eo--NAMt ..wU .~.~r ~Y OAtE 0i OEwM ~ row~., re.~~ ~s~r~~?w~s , JOHN W. MASON t Male , i September 15, 1976 tAQ ~r.n. ••~ow ...nn•r. ~.o...., AGE -~•s~ o.oer . n~• uwe~ ~ 1~~ CATE O~ N#M ~.~o~wr. s~~. COUNTI O~ OtAiM ~•c . s?~(u.. N~n.e~• .~f~q. rOf Mq MOYN .~r ~ea~~ . Negro____~,. 54 w ~tar. 11, 1922 Hillaborough ~ Cut tOvrK. O~ ~OCwt~ Oi OE~1M ~«uN cm ~r~n ?10SHTAl OR OTMER N5T - ~r .o~ nur~. o~n uMn w..wn ~ 1'v•• ~ wcn.qsa+a n Tampa~ Floridtt r. No Veterans Adminiatratfon Hoapital S14f! OI N~M . u~o~ ~r v f~,~~r~ cinttr+ ot ww?t cou+t~r MARwIFD. NEYE~ MARMEO. SUfV1Vf'1(? S~OYSE ~ M~r1, OM ~~lw wri ~ cow.m ~ w1DOw[O. O~Cfo ~ wcrs ~ ~ ~ Louisiana . USA N Married Sarah Walden SOCut S[CUnTr r~lWEt ~ 1lSUAl aCCU1AT~ON ~an a..~ w rou oaw w~»q .w~ a [1NO Of N~Sa+~SS O~ N~OtbT~Y +wau~a ~ut. tqM r nn~w ~ ~r 437-18-2380 Brick Mason tfSipfn~E-St~IE COUNtII - ~t?t, iOwN.O~ IOCATION r~s~N un ~rw~ STREET L~~ . i Vlcin N~ O~ r0 . Florida ~«St. I.ucie ~w Ft. Pierce ,u Yes ~,.2911 Dunbar Street IA111[R-NA~ME ~~y~ ~~p IMOTI~R-MADENNAME hflt r~~ uW ~s Albert Mason ~s Brandon ~nro~t~u?at~w,wE rulr~G wOwESS ~uwt~ o~ ~.r.~ .q. cw. o~ w.«. a.w, tr~ v. Mrs. Sarah Mason Wife ~n 291I Dunbar Street, Ft. Pierce, Florida 33450 ~ ?w~r ~ ocwn~ w~s uvs[o sr: ~trvr[~ o.wr a+[ uus[ iN[ ro~ p~ Al wr~o ~sl~ ,a~.e.» a.M+ .«....M f ~ ~...wn cws~ ~t I CARDIO AS OLLAPSE 5T. WCIE COUNTY flA. ~ ~ 1•~ C[tY+Cl~oVc.st Q c FOC~nP01TRAS ` ~ ACUTE ~ND CNRON C REt3AL FA LU ~rrjFD VE?'FiED ~ f co~enw~f. ~r J ? , .w~c« o••t ns~ ro 1~1 ~_~_~(f'~`~ p~LL H~ ~r~~N~t~ C~YII ~~t, M W, O~ ~ COwNOYfMC~ O/: A ~ ~t1fIM0 t11~ YM~~~. . _/~~L~()~O ~ l~/MO C~VN v p~t ~ 2 3o PM l..J { ~ ~wfi ¦ OiwER S1G?+uKwNt CONOri10nS~ ca.aao..s caw~r~nao ro~e.w~ w~ r.o~ ~n.m w c.,rN or+e'. r. r.n ~~a M ~Ef awMrea ca+- ~wa a w~ p ~i ~m~rrw «w y ~ * Yea ~w Yes ; i p• ~ ~ ~1 w~uot~ 3u.~i6i ~ ~ ra.rw, n... Mpw INIW t OCGY~REO 1 fMq~ 1Y111r W IMll//~ M IYt ~ O~ ?~M M~ wr. ~ ~K~OE, OR uND~1ltMeu[O ~a ad~1 ~ 7w 1k . M !M IN1U~t AT WO~R ~IACE d l11Uf~ u wor. r•o. ~ned. ~K~On. IOCADON ~ fhq~ O~ ~.r.~. +q.. tm O~ Mra. N~N ~ ~~nc~n n~ W~+0~ OwK! ~?~o . ~K ~ frK~n ~ . ~ ~ ~ f Cf~~NKwiK~- . .owrw Mt ~~Y ~OMM W~ ~~~t ~rr 4~t M~ ~/MN ~IIh ON ~ M/OM M01 1rK'+ ~ wwe. occuwo ~1 tM /Y(~, pn ~y ' /M~1 ~~N TO ~M M~ ~/Y ~OF ~„M M~M. IMOW 1 NI/, ~w~, q ~M MM ~ ~~1 %~p~ Au 17~ 1976 m Se t. 15 1976 n~ Se t.15 1976 ~N - Did ~N 4: SSP M o:~', ~ CE~I~iKAf10N ~-~+EOKAL~~AMINE~ OR COtONER o.~ nN Wn w ny ~py~ p a~M tw~ McfefM ~r~f MONOwK~P N~e ~ ~~~r~a~~qw p n~f ~oOr ...eiw ~w ...n+w••,o.,. n. ~ M~+AM. Mf ~tu w0~ Oi~s O(tW~to o~+ ~f O~ry ~~+0 ~M ~O M C~vf~~f~ ~t~l~• 7b M ~ Cftl{flE~ -HMtE ~nn O~ rn~+n K'~NA M ~ r MWff O~ rny A ~.0..~, M~. rW ~ JO~PH _HOROWITZ , M. D. ~ . ~ M. D. Se t. 16 1976 ~ wuKU+G~oo~ess-ceRrrKe arwnw....e .ro - o. ~ u Veterans Administration Hos ital 1 0 North 30th reet, Tam a,~lorida '~3612 ~ ~tM~wl. C~ ~EMOvwt OR CREMnt r-w~u~E IOCw an a q... ~„n ! y ? srfc.n . ~~~f~ - - - - J-~I r-~ - !M - - ;y OA1 0~~. fU 4l H - AN S ~ n Ir w0 . 4r f~~t1 t ~ ti ~ .,r ~y~ • ~ i. iUNERA Olf R(G4S1RAt S1GNAl1/!f OAR tI I!O ? Al Gt3tV~(~ ~ ?1~ lL.~, ~ U / ~ ;3 g I NEREBY CERTIFY THE AdOVE TO BE A Titl1E AND CORRECT COPY ~ , f!F THE LOCAL RF.GISTRAR'S RECORD ON FILi: IN THE HILLSBOR(~1CH ~ , Ca1NTY NEALTH DEPARTMENT AT TAMPA, FL(lltIDA . (WARNINC: N~ . ~ ~ VALID UttIZ83 11AISED S TH8 qILL3S0Rf1l)GH CaUNTY HEAL~'H , . . ~ ~ ~ ~ oer~r ia ~ ~ ~ " ~ ' . ~ , , , . ~ ~ ~ . ~ : • Jo . ~ieill, N.D. ~ H.P.H. Director ~ ~ ~ ~ 6COK~~ FAG~ ~6~ C n y~e~lth Offic~tc b Local Resi~trar ~ ~ , • . . . . ~ , , . ~ ~S . ' • - , G~~/, , \ + ~ • - SEP 2 11976 ' r''L'~-'~ , ?t~r.~. M. LuPp•n~ • apu y eai.c~r.- r~~. ~ n~ r.~ . . - - - • -