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HomeMy WebLinkAbout0240 359988 ~ S j y . . . su~ ot Fioad. CERTIFlCATE OF t~EATH Department o! Nedth ~nd Reh~bilit~ti~re Senices RwTS ~~~t No. _ VITAL STATI8TIC8 F L O A I D A 57 ; ~cniaT~~w s ?+o TVPE OR rRINT D!C!~?ifO-NAIW •~a• ~wu t y~a DAI! d 0l~TN ••o.~~., ~e~~~ ' 1 FERMANENT ~ CNARLES TIPpINC , Ma,~e , Ja?uuv~ 3~ 1977 ; BIACK INK t4CE .~ww. wow. •.~acw ..w.r, ~G!-..s~ w~~ . a.~ wM;~ Cwt! p M1N ~+aw¦. w.. COlAttt p Ol~tM i ~K r wtw . s~pw.. . ~an ~ +os Yq MoMf .s+ n~~ ~ ~ sso2 , wh,~.te a4 „ w 26 t E92 cU ' ' CI'1t; ip`wM. Oi l0'UtWN~i~ ..sw c~. ww MOSMrtt p OMtf M ~ ~r .~w ~nn~. c.w ~nur .~w wr~~ ~ ~ ~ wc~. q~ e~ re j f.t. P~.~tce Yee f.t. P.ieh.ee Mes+o~,ia.t Hoa~i,ta.t t sr.n a w1M .r wOr r ~~~,~~q N M11y1 COIRAtt M1NMfD. ?KVt~ IM~rlO. 3tIfYKNG S1'OVSE ~r ~rq ~y~r .rw ~ ~ ' • ,I /~~~~.~J~ ca~w. ~ ,.n. ~_~(Q~~~' /yQ~~y~~{j~ V W4! N~MM(! ~ YVY1R/1{~{. ~ ~J/~ ~ f~ ~I~V~YGU O I MKn ~ 11 1'OxG ~ ~rMN NG~Y~ ' _ ' " , _ _ _ _ ~ r~e•r SOCW SE[UM~ NIlWI~ YSW?t OCC1M~t~ON ~aw .w a~.ow ww w~w.o .•ou a lW d ~1lSNlSS O~ 1~01lStft «cwr~ w ~Orw~ ~M. MM ~ MMN ~ ~ „ 135-01-1621 „ Pu6Lic se~tv.i.ce Gq.d 8 EPecth.fc Neuxytk,_N~~____ ; ~evN.~a N~oy ,wf ~~lSOENCE.-StAI[ CdMTt CRf. fOwN. Of ~OC~1101+ ~•iw uw ~~ws St~Elt ~NO ~tW~ti i Floar.i,da St. Luci.e f.t. P.iehce ~;«~'ed ,y 111 Ind.ian H.i,CLe Va.i.ve ~ ~~TR~-part rw .+~w~ MW~4~-w4Xw a~r~E .rs. +~w~ CfuvcCte T' 'n Jane Cu~leu ~IMO~M~WI-qM~f wiAtM6 AOOM33 ~s.Me w~~• ro. cw. ar ro..~, ww. ~r~ j ~h 1?~t.~t K• S-i~nnone 601 Ave. 6 Fx. P.~e~tce ~'C 33450 ~ ~ ~ r~* ~ oewnr wns uuuo n ~c.~rt~ o.re ? o~r c4v~t +r~ ise ra r.~ wl •~+e kJ~ ' t , j » I MTnlM OIO~7 ~r~ M~1~ ! ~ ~ j ; - a~ , ~ f : ~ ' y • . i ~ (OrM~Orf M uw • / • • ~ S ~~.cr ~.r( ~~f~ ~d 1~1 ~ ~~l~l / ~ ~,S ~ ~~'G?[~_ ' ~r~IM~t~ ~~~f~ MM. ~ ~M b. t a CM~YOYfKf d~ ~ C, ~t~nw~ t~~ w~~? ~ np.~ c•w ua ~ hi ~ Mt! • Oi1~~ SIGNMICAN? C C~~~~ b NaM M~W/ YuM~ ~p t~~N OMw r~v~ ~ M/ r r[S ....a¦es ca+ ; p . ~ a~ o~ ..o. r«~n Mn..n~..~ ~..r o~ ~~u~ ~ - A 1w ~ tl~~~wo q~wr+~eY ~•ws. n•n Mpw INIINt OCCNt~lO'~ ~rN~ rqM O~ w~wN~ ..w . o~ ~.w wr~ n.- s ~ fw iM r 1r ? ~NJIJ~t wt w'O~R R/Kt MJURn ae .or. ..u., ~nN+. r.nw+. IOC~ NOw . aran o~ ~.•«o . cm w~o.«. a•w ~ 1 ~ ua~n a~ a.o ~ awut wo . at ~ ~wcro ~ ! ~ 1M ~ ~ CtRtsKJ~fiON- .a.~r M~ w.~ .a.~ n.~ ..w us~ wi.p .~~w or . w~.r ..a w•n~ occvw~o .r we nan. w r.~ ~N~lKie.w: t0 ~ ~a+~+ n ~w. . ..wr. e.w, u.~. ~o r w~~ r ~m.~t~ wn /~~S r f ~ ~~p a ~w..~w~. w~ ~ !N N~~•u~ .w. ~ /•J ' ~~q / ' J~' / t~. , - ~ ~ tN ~ tN f' [M ~e r~ cwr.s~ ~~.w~ C[li~iUtrpFi-~ilOK~l l~~~v~[R q CO~ONl~ w~ usn a~w .o~w o• w..w ~M~n ~~f ~wRl~ My ~ ~tu~ubW+ d,w/ p~~ ~N/p p~ Mf3~r ~+0~+. w O~~wO~. . ~ Mt ~ M~~ MO~r~ Han~ OtCWNO br r~ ~~q u» MI~ ~O +M UvN~U f~~it• M 1!~ M I - CtttM~E~-?+AMf ~n M..v SKr~t~itAti ~w«~ o~ ..~e ~b~ SK+?~O ~~A. M~. t~Y~ tl~ ~ - , - ~ ~ ~ ~ ) ~ _ . ruR~K, ~OO~ESS-CNr~R~ i' vMn w~. ..o~ cro s~aq rx - ~11M~1. caEw~t~O~+. ~l++O~~t WEte o~ t~t~u?O~r~N.u~t" tOUt~oq c~n w~o... s•.a ~ wtws. 1 But~,ca.C - - - Ni.e.Eehe.d.t I?lein._ (~fne, _ F.t. Ptehce OA~~~-- ~+OM~w, M~. h~~. /U?H~,II ~0+~[- rJ~Mt ur0 ~t00~(Sf ,~r~eir o~ ro . en. M t9~r. f~~p. tN r Feb. 3; 1977 Ba.th Funenn.~ Hom 901 N. 7Xh SZ. .Ft. P~.ehee. FC. 3i450 V.S. #812 ~ ~ tlG~s - •?txt e~n nu..w iocu n~nr~u Rw.7/7s t,[~ w e 1 1977 ~ nerebr certity ~his to be a true and correct copr of the Locs~ ! Registrer's record on file in the St. Lucie County Heaith Depart. . ~j ment et Fort P~erce, Florida. ; (Warning: Not valid unless raised seal of the St. Ltxl~ ~ Cou~ty Heal~h Departmem is affixed.) FIIEp AMD RECOFlDEO _ St. WCIE COUNTY FU. • ~ , ROCE~ POIiRAS ' c~~aK c~acu~t covat + N. D. MItcER, M. D. aECOaa~vE~iF1E0.....---- ~ County H!!h Offite? d, lpcd Repistrer ' ' - i " Na~ I I 2 s6 PN'1T ~ . ~ ! ; a~ D~putr LOC~I Reois?re~ ' . ' . , ~ . .s , 359988 ~ ~ ' "t~ . ~ E"~ ~ PAf,f e)O : r; 2 , . :