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HomeMy WebLinkAbout0259 i 1 . 'i ~i ~.~5 , ~ State of Florida CERTIFtCATE OF DEATH ~ lleputment uf Health and Rchabilitatirc Services F L O A I D A ~TATE ?~~c No VITAL STATISTIC5 pfG167RAR 5 HO 22~j ~ 7VPE OR PRiNT DEfEwSEO-?+~wl .~ee.~ Sta OAIE O~ DI~IN ••c..... .t.~. ~N , VIpA ~ PEIER90N F1att~le i, mril 9, 1977 PER~IANENT BIACK INK ~CE .~n. N~cw. ..r~K.r n.~u.., ~GE-~~f~ Vw1~ ~~~~t VwOt~ CA~E O~ M1M Mr. COIK~11 O~ OEAIN oc. ~ srecr. o~ww.. ~.a~s, -------F-- n.~ ~ . rOf s..~ .w~f ~ ~ 6602 ~ite wr 81 ' w ~ June 3, 1895 Saint Lucie , CITr. ~OM~M. O~ tOCAi~ON d DEAIM ~ ti+w~ t~ ~wn NpSH1Al OR OTMEt HSTItU~ION-N ~r ..o. .r ~~ny~. on~ ~rM~. •w .ww1~ ~ Wtr• •If O~ MD n FOrt PiexOe Yes r. ~aster Marlor IQursiriy Iia~ ; . . - ~ • STAI! 01 N~M r r.~m w v s~, w~w CITIIEN p W11A1 COIMiW MAltl(O. N(vE~ MMIIIEO. ~S~P/fd[' S?OUSt ~A~. Ow~ MOIM rrw r ,coww.~ W1ppW~ p. p~v0 ~t?tcr.~ f ~~L~,.y. . . ~7~7~ ~~~~~~7~~~ 1 ~p , tu•~ e110fKf ~ ~iC.~l1. VL~~~ • l/J[1 N ?liVlJ~fRl "11 "r~^^ . ' . " ~..I~t M(~~Y~ _ " _ ' ...."'"__"""'.L"__"'~..__""_'_ ~ ' .,.~o w~w SOC~At SIC7Uri NUWE~ USUwI pCCW~tqro ~c~.~ ~rs o..~w~ ww w~~~+c ws~ a~ RNaD d M1Sr+fSS M~OUST~r - Jcl~ap~ w ~OMrG ~W. hew N ~~~~Ie ~ • ~ ~ ~M „ 261-56-4910-A „ S~pervisor of Registration Saint Lucie Qounty _ _ _ _ _ _ _ _ _ ~ ~ISrW+~(~ MMM ' T____ .orffor ~[S~DINCE-SfATf _~COIMi~ Clfr. ~OWN O~ IOCAl1ON _ 'w~ ~W~1 SU/EI ANO MlMU[~ . ~recw. w .o Florida ,b St. Lucie Fort Pieroe Yes ,w 2007 Oranye Avenue 3 MtNt~-?a~u~[ n~s~ ..~e~i i•f~ MOINE~-A41D~HNUNf ~rs. .ear ~ ~y 41~r1~ l~~ U INIOUMANi-N~ME Mw~NG AOWf33 ~sran w~~s «o. crt• a~o~., ~~.w. ~r~ Mrs. Harry KiCliter ,~P. O. Ii~x 405, Ft. Pieroe, Fl 33450 _ r~~ oEwm wws uusto ~Y: Kr+r~r a+~r ow[ uux n~ ~.+c ro~ h~ w!. ~++o I.H MA~~M OMUt ~M M~~M p w~iy-BT~i'i--- s - . { ' COM~t~10Mf. ~I ~N~. ~ ~ ` MPICY O~t~ ~1!/ ~O f . ~WM~t~ [~~f~ Ip. MM q. O~ tl~ t Oll~wcf ~t~nu0 t~~ •~~tr ? / i ~a..~ c.~w ~•u : j • kl i f wU~dS?~N r~S w~R n.ares cw ~ IMt ¦ OINE~ SKrMMKAMT Cd~WT~ONS CM~wOMf (OMMNw+G q N~w. w~ wW ~u~e~ ro C~vN Ow~.' ru~ ~ w. ..~s o~ w~ 1 MN~~a w M~~~rnnMO 4oN ~ o~ ~~nw . a~~ i rn P.~,~ I~CpDt~1~~S41~~ ~A ~~p~l~, M~, q~~ ~ MOW IHIYAT OCCWiEO ~~•A~ whr~ M w~o ~w ~~~r ~ w r~N n, ne~ 1 ?IDM~C~OE: O! N~~flWMAO , . ~ _11~ ~ . 7M M ~C/ ~ IN11l~1 A~ ~MORI[ hACf W N1U~~ «M.'?er. f~4~t, ~~C~M~. IOCAiION . ~~n~~t W~.r Y wo . an W~O.r. t~~w ~ ~ ~nc.n ns q «o ~ o~+n uo . ~~c ~ v~cwn ~ ~ ~ ~ ~ CERTKKAtiON- ro..w~ nu .d.w •~u ~ u+~ u~+. a.. r..i.e~ u.n w~»iarrw ww w~rN ot[w~ o.. .n n.~~. o+ ~we E •N13KI~N~' . / i ~P~M Nt Ay W~~ ~~ry~ M~~M ~n01r~~ ~ MM. ~r0. q wN N1~ & t9 I/~ T~ 9 ~ M rl ~W'~11Y~l. OM . fl~ wu.sNOie rw. ••~J _l1u y~~• / 111~ y~ y~~ ~ )i~ lb 7~O M ro aN cwsus~ fune CER~YKwt~Oi~- rFOKwI Ei~wri+E~ O~ CO~OaE~ n+ .n ~si.s v rw .oM a M•~w ~ec~~ ~.s r~a.ou«c~~ a•~ .r.• .ov. ~ ~~......sa+ w nr wn wio~ „a ...n.r.•.w+. w.. o?.«w, , ~ ~uw~ occv~«~ o.. +r ~.n o.~ w~ a aw i.~rsai. sr.ws " 3•.! _ D ~ ` -l-~--"----77+ < CE~IM~f i~AMf ~~rn o~ iew~.-~ ~ S~Ci?~ATUfE Man~ o~ n~ bA~ SIGW40 ~~~w. w., .w• I ? ~~1.1_S~ 1~~~_QSLtY~_~ i~ ~ ~~7~LwP.~~~/_/~~_ . MMIWG ~DD~ESS-Ct ~ c.~ ~ ~ a +o T~~~o.~ s~•n r~ )L WR~AI. C~EMATq?~. rrOVAI CEME?En OR CREwulGtr-w~rt OC~t~Or~ cn. w w.» • s+.~~ ; ~fnt+~~ ,N Buri.al Fbrt Pierce Qen~~xy Fort Pierce Florida ' : ' _'___'1____'___-______-__-______'..'_'__~_____"~_-_'_._' ' ~ ~ DATE nW~w. Mr, .~ur. /UNF~AI HOMf--NA~M[ ~r~O ADQtlSS ~ f~n~r p• o ro. ar• W~o~+. a~•v. t~r~ ~ ril 12, 1977 Yates F1u~eral Horne Box 777 Ft. Pieroe, Fl 33950 ~ VS. ~612 IWElA M 7 - n[G+St SiG?+~ry~ ~ o~.f acnr~o ~oc•~ uonnu ~ a.~. ~/~e »./;r i ~'i'-~- 'r'` ~ ~ ~w 4-13-77 ' ~ ; nercby ce?t~ty tAis to be a true and correcf copy of the loca~ ~ ~ •._~;~strar's record on file in the St. lucie County Hoaith Depart- ~ ~ n,ent al Fort Pierce. Florida. ~Vllarniny; Not vai~d unless ra~sed seal of ihe St. lutie _ ~ County Heaith De~artmenl is affixed.) FILEO ANO RECOROfD • . . sT. LUCIE COUNTY f~~ ~ itOCf a POITRAS . , N. O. MiIIER, M. D. ~~_ERK C~gCUI? COUR1 _ County Nealth Offiter ~ Lotal Raqistrar L'f F f1E0~•~-~"' ' . ~ i.~ - . ' Ar~ 1Z I s~ PM'1~ " - . ; ~ : OoN Deputy loCSl Req'. tr~r ~ ' ' ' r ~ ~ . i . L - . r~ • • : . . . : • ~ ~ = it;. ~ ` ~ ! 1 ~ ` 1.111~ tl.1' - OOX~~ fl1~E