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HomeMy WebLinkAbout0545 354288 ~ ST-38,465 ~ ~ ~ # r~» ~TAT[ ~OA11D w Nu~TM CERTlFICATE OF DEATH eoaes • ~ •UAiAU 0/ YITAL fTATIri1C~ fTATt Illt NO. ---_-y- ?•R•, FLOBIDA urd •A~w BIRTM H. RE61 RAR'S NO. t~G6 p~op~~l~ GOD[ NO. IfiYAI R[YO[NCtlr~w.Iw~+rMa 1/.w.wpw~ RrJwwM~•.~.wi..) .a•eut•~ 1~Ct O/ K~TN 37~TE couwrr •~a 001NT 6(~-~tkX I~lorida St. Lucie De St. Lucie ; ! n ~~f- S. d1Y. TOMN. W1 IOCAT104 f- ~S K~CE O~ OEATN t. pir. TOMtM.Ow IOCAt1011 1. K 11[S~0[hCE •~e~~l ~ IM510E CITY IIMITS/ u~S10( UTY LU(1~5~ ? r?~.. indian River in Hoat resp Mo Cli Ft. Pierce Rural .FSp ~oL~j ~ N~NC Oi IH w~t f~ ~N/Ihl. ~Yf shnt etMtMl ?[NGTM O~ I. STA[ET 10011ESS OM 11 f4AY~ ~qy~T\l 011 S7 M N ~ ~[S ? MO ~'j Y~STITU7qN L_ I an River 2~rs. ~ 4.701:A ~ , ' ~?u?~rc o? F~.r A/Mrk I..rr • wr[ M..N !n~ - ti~a oceusto ~ 11~ lybl ~*~~rr~«~ Geor e yonroe yorris ouTM Dec. , S. SEX i COIOR OR RAt[ MnItRtO ~/.MEM[R YAlp11ED ~ aT[ Oi M~iN ! A6[ 1/~ MM~ r 1 TW Y+L(~ 2~ wK. M IM~?(y~ t) XwW D~~ Nwn Nia. 1:• ~'i~l@ Yila~tie M100NfD0 qYdICfO ~%{i• 22~ 19W f.l ~ 10~- uwu occw~Tp~ loiee tt+~ Mw.~ M.~ 100. Rwoas wswcsso~ u~ousr~r 11 ~TMK~C[ f A~tt w JMN/~ ~wiM?~~ ~ rn~a.i or .wr ca+~m.r .ftA ~~r- I~~iyiwafNv~rti~IhN•~••*a?N+?~~ ~S Cusseta i~eo a USA ~~n~At Driver l1~Ct twt Il. fATME1I~S 1UMC i1 MO7ME~"5 MJ110[M INY[ - . ' i e~ - i ~,,...ia.? LaFa ette horris Osella tlarris IS. NAS O(C[AS[O CYEA 1M L S. Al1YE0 f'OAC~Y 1~ SOC1K SECURITY MO. 17 INfOA ~ MQIMiVIK J~w• Yates 1 fw. r. r.J+~wJ 11I ~n. ww~ .v ~ MY~ ~I r^'"r ~ Yes W'~J 1 A•a~.. tt.Yierce-rla.~-_- 1~. CAYK N~tATN (JiMt+ Mf/ Me t~wat pt~ tut h N). (Sl. ~w~ ltl.~ . tMTINY~I ~EiMi[N Pua~t~l pMSET AwD o(~tN ei.•ca•• ?~~T~ ~~*Nw~suuscow• Atf~1arent_ ~atura2 CaLSes__ ¦V~t fU• IMYtOMTE C~tISC l~I `-.-CC---- - . . . - - - tA• e~r- f t1Nc~t• C~wliliw.iJ~w/. oUETOI~I____ } ~ft~ tA• t4r~ ptt tist t~ . ~ 1 • e • I ~Ew< <ww Nl. . d~ri~ t~e r~In- r• f~tr~r OuE TO (~1_._. - - - - ~1tAlw 7~ r~i'a nrre lwt. - - ~ O M11T q Oi~EI~ SK~s~fJwt OO~O~/~ohS WrtMUtK ~o OUrN RR Mot ~[ut[p 10 ~M[ ~Urw~? D~YI~sE CwiOi nOw G+KM w?rr ~(~1 w~s ~utoasr horr• •r- , n.~onr~o+ a..a. 3 .csD MoLr . er t~f~?• ~ i ~~x~~ ~ w~rotcwucu /ti+~~. wrw~ N+~h•~ iw Pwr I r I'vt Il y~~w H 1 ..t~.~ •q ~ ~ ~cc~ocMT wKroc ?arKwE - u O O U - • ~ •t - - - mr T~r[ os I/wr Afd~. IM~'. Yn? ' - - d7• ~ nuv~r w. o n- £ Z t01 uuu~r otCU~~EO IDr. r?~C[ os ~wv~r (r. b~r ~A.rt N.~. 7D1 Crtr. Twr~. o~ ~ou?tqM Ccw~t• ST~T[ _ NNRE Ai ~ ~QT ~NK[ O ~A• /~M1. /hlff. ~~tf Wl/~. (~t.) ~ ~ 1MORK AT *OIIK 21 I~ft~nd~ t~ d~e+~s~d /rom . to _ •nd I~sf s~~ ti T~/i?s on . D~~~A oceur?~d~f ~ n~.Q~_A~_._ on eM d~N ~t~f~d ~bo+~: ~nd fo fM Msf d m7 Mm~l~dN. /rom ~M uuwa stat~d ~ ?1l lt~~i ~ y~Q~iY~ (IM/rtrrf41t) ?2A ADO~ESS lZc. MiES~GMEO •r• to 1• ~••pie• • J.;.. Sa:n le ~ount JLC,.-P 'rt. Piercc: 'rla. -1~-~' •tl~Nt~. ~r tiaYE O? CEMETiM~ OR Cp[M~1~lY 23f tOC4Tqw f(Y~, /~rs. r r~w~?)/ <<Tr~~ ? 27~ RA~I. U[r~tq~. Z1A O~TE 11[rOUK 1 ~D'K~II~ n ~ Burial _ 12-1~T61 ~ ro~t °ie:ee ~e:r:etc NL P' rce F~~- - ~ ?.,.~A17 j{ NME~~I OYI[-C~OIt 3 SK.A~70RE ~pDRF55 Mi[ N[CO. ~r IOC~L ACG A[GISiRA11 5 S~~TURf ~ i'aa Jose h'rJ. Yates r t. t i erce r 12. 1?_-1 -EI Anna L ~ i hereby oerJity this to be a uue and cor~ect copy ot tt~c lacs~ ~ Registrar's record on file in the St. lucie County Nealt~ Dv~aR- ~ ~ ' ment at Fort P~ercc. Florida. , (Waming: Not vafid unless ra~sed seai of the St, lucia . , County Heahh Departme~l is affixed.) • - ~ N. D. MIIIER. M. D. . Courrty HeaNh Officer b locat Ra9istrar ~ //-/~-1~ ' ~ ~ - _ ,....~JI ~ - J~N 5 3 s~ PN 71 ~ aa oew~n? ~i R ~ - fJtiL0 AMO pECOR~F~I {T. UCIE COuNtlc.ilA. , ~QCF3 P~ttRRS C~EIIK C~ACWi C~tIa7 ii~ R[C~110 vEAiF?EO ~ • • ~ i. 6QCX~~(. ~.!!'c 5Y~