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HomeMy WebLinkAbout0639 . y, . . _ . 3~8309 palm Beach Coun ~:y Health Department CERTIFICATE OF DEATH ~~ryrrlmtnl o~ ~(~a~lti an~ kr~~a~.i~itdire ~erri~~rt F L O R I D A s~*wTE FIL[ NO. _ - IM~InNI~ Ik IIL..\I 111 e~ ~ TY?[. Of ?~INI IN ~W`"~`R"n•~~~ REGISTRAR'S NO ~tlMAN[NT ~NK OECEwSEO-~+~ME ~~s~ SEi OAiE Oi OfAM ~+o~tw, o~~, ~e~~ ~ SEl N~MOWOI i0! ~rsrwcta~s , ~~,gIE M. WORS.CE ,Female ~ AUguSt 28~ 1976 RACE 1~w11~. Y~G~J. ~~UK~M ~ww~r, AGE -~.a~ ura~ ~ rt~~ vwt~ ~ w~ CATE Oi ~I~TH ~ rwaw, e~~, COIp~Rr Of OEA1H nc ~ s.u... ~ a.mo.• ~•e.q~ ..os w.~ ww~ .r •a~ ~ - ~ White 71 ~Feb.14,1905 Palm Beach CRT, TOMM. OR lOCA110N pf pEATN wfie~ C~n ~r~o NpShTAt Ot OTMEt NS11TUi1p1-N ~N r01 ~r ~rtwl~, G~7 /tMf~ uo wwt~ ~ ~/~/p sncr• .~s o~ «o ~ Boca Raton Yes Boca Raton Coznn?unity Hospital SiAiE Of ~IRTM ~ a ro~ w v.s CITI2EN Oi Mlw?1 Cp1lP1illf MARtlEO. NE~ER MARtlEO. SURVIVNG SlOUSE ~ w~x~. o~w n~o~M wre ~ town~ ~ o o ~ w~.. ~ ~s~.~ ~ New York . U. S. A. _~„~I iaYr°~°~`ec'~ John w. Worsoe ~.ue au.seo ~~~t SECUa111 NU+~Ef USUnI OCCW~tIOa ~ c~a .r.o o~ +~wa oow owu.c ••os~ a Kwp Oi NISNESS OR u+OUSTt~ ~~10 Y a~A OCtYM~O M ~OMwf. l.N. MM N~III~IO 1 ~M „264-41-5286 Home Maker Own Home ~eoa~+u wroa 'Ori~~'p' • RESWEnCE-St~IE COUntr CITt, TOvvH. O~ tOUt~O?~ +~s~w c~. ~~+~n SitEEi wN0 NU~tER ~ v~c.~. .u a w ~ ~wFlorida ~w Palm Beach Boca Raton Yes 283 N. ~.31st Street fATNER-NAM( pqt r~Op~ ~ t~ft MOTIIEA-A4bEN NAME ~yf~ rWp! u1* , ~s Geor e H. HeideZ T.ouisa Hefner ~ INIO~NT-?+NwE w?twG ~OOeESS is~a~r o~ ~.~.o ..o. cm w ror.., i+.n, tr~ ~,.Mr. John W. Worsoe ,n283 N.E. 31 St. Boca Raton, Florida ~AlT t. pfpM WAS CAUSEO ~11: (ENffR OMI O/~ CaUSf IER lWE fOR bl. (A/. n?1D Ic11 qn~iM ows~~ ~uw M~ r.rouq 4wS~ A' NI i~/ /1 ~/~J~J ~V~ d0['16~: ai"~~ o.~~i3vi" . co.o~voMS, v •.n, , ST~LUCIE COUMTY F~A. ww~M G~R us! r0 . 1~1 ~ ~rrtN~t/ C~YlI ~0~, ~ p. «~f ~ CW+3fOY~K! W: 1 ; f~~1~Mp tw~ yMOI~- ~ u~..o c.~ie ui~ ^i Ei~K C;R6tJIT CCURT ~ . ~~y . . • EO ~ ~ IARi OTMER SIGN~KANT CONOITIONS: tO~~aea..s cawwv~~nG to eeuw ~vt Mpr uun~ ro u.rf! G ~..u+ . w wUtOKr rt rE5 .e~~ ~~MOIMOS C ~ U I I ~ S~ ~ 7 sN0 ~ 1w oe: MM WI~~~IMMO f 1 ~CGOE A E ~..oNrw, w~, iw ~ ~ e.~re~ ..~nnt w~~ivn r.n ~ o~ ~1ur a, n~r ~ f ~s « 1~~E~~ MOW IN/tllY OCCUUED ~ ~ !w 7w ' M !M ~~1Rr ~r woRK ?uCE Or Nx~r.~ ..o.e. sr.H.. ~.c+w+, lOG?i~ON ~ ~ni~r o~ ~.r.e. wo.. cmr o~ ~orr, u.n ~ k 1{hC~A A1 O~ MOI p//1a y~p., ~K. 1 f1/(M 1 E ~ ~ ~ GEtfN1UT10N- rw*M O~~ ttY nO~~M O~~ •lu ~MO 431 LV ~ur/MH uM OM ~J/)WO r~Ot r~[w ~wf OIAfN OCCUl~IO ~i ~w! ~1K(. Ow IIY ~NTfK1/~N: rOnM O~Gt ~IY ~OO~ ~~fl~ M~M. ~NW~~ O~R, ~r~C, b M N .•m.w~o .Mi e~ 7~D T~ p~ v ~O ~ 8 ro na cw~~ii~ n h. wu.uo,.o. .J ~ ru I ~O 7~o n. ~p n~ r~. s00 CERtIf1UT1pN-MEDKwt Exwiwl+ER OR COtONEf. o.. ewe us~s a ne ~ww o. a.n. ~we wuo~.n .•s r~o..w..ce~ oe.o ~YU~unO» p M! ~OO~ ~MO/O~ tW wtNt,C.~t~p.~. ~w ~n pw~W.~. ~Or~fw C~~ rl~~ .OVI Of~M OCtY~HO Ow Iw! O~~! w0 OYf M~[ C~VMISI ft~l~0 - j~ M J}~ A CERTIiIE~- ~~n o~I n S1CiNA E . ~e o~ nne OA E SIGIiED ~.o~n.. w~, ~~u~ fi ~i~~~~P7~ ~ ~/d~'A'Ge.x1"i. D. M. D. n~ Au 30 1976 , ~RMJGAOO~ESS-CERiN1ER 600 S Dixie~-~Hi hiwa Boc Raton Florida t~~ ~ ~uew. tetw~r~o?+. e[MOvwi CEMETEf1i OR UIEMATORII-N~f ?ocwna+ a~ o. w... s*.n - ~ s..c.n ~ :aCalcination Kraeer Cal-Cremator Pam ano Beach Florida O~TE ~..o~.rM, w+, .~.n fUNElAI MOME-/UME ANp A [SS suu~ o~ ~.r o ~o , ur• w ro.M, s..~~, c~?~ ,y _ pt.1,1976 Kraeer, 1353~N. Fed. Hwy. Boca R ton, Florida S. ~6 12 ~ ERA SM!/. RE RE TJAt-S1GNA rvt ~ t 1 tEGISt~~~ ~ ~Rer.1970 1S~ ~Q~ Z~Q9 M ~ ~ ~ ~ ~ - - - - - - - - ~ s ~ , ~ • i ~ . ` ~ s ~ J I HEREBY CERTIFY THE ABOVE-- ~,~;'~A+~~E ,AND CORRECT COPY OF THE REGISTRAR' S RECORD ON FILE IN THIS OFFICE ; ~~~r ~ ; ~ C I;,~~:C,¢ : : : , ' (Not valid unless the ~~airO~SE~~"'~a ~~~Ch County Health: Department is affixed) • . ;F'.. . tr_ ~ q~' „ ~ _ i , ~ ~ i y~'' ` . : : " - 0 E p r._~~*~:: ~ ~ . % 4 ~ F' ~ t -s-w t^ September 7, 19?6 ~l` : O C, sr bac~:, M.D. _ l.• - Local • Registrar ~ i. . R Bureau of Vital Statistics ~ ~ . " BUOM ~~~7 PACE West Palm Beach, Florida . , . _ . . ~