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HomeMy WebLinkAbout0686 ~ ! n ~ ' L_ ~ ~ ~ a i~ i. ~ ~ / r , I ; i i M ' ~ :t3fi8~~, ~ . ~ + CERTIFICATE OF DEATH ! I~Nrewl ~1 IIe~II~ ~wd Re1w61111~NK $enkH lTAt[ Rllt NO. nnwnw ir u..~.iu F L~ R I D A 489 ~ t~?~, p~ ~~11~1 IN ~~w~r~~~~ MtO1fT11A11'! NO M~M~NINf INR A _N •~N• ~M~~ ~ i OR A • row _ •~u ~ ~smaMe ~ ~ ~?ntan. Mc~ri. ~ ~3.. , ootob.ac 3, 1976 UKt ww. M~W. ~NNCaM wM~w, AOt-~~f~ we~ . ~ ww~ ~ . Mqt! ~O~r~ MnN ~.a..w. w.. cas.rr a a•rn - 6~~2 ~wtw~ ~~"'lt: ~nu~~ ~.os rn wwn .r ~l~7.~~1 1~ ~~8tr~ Llb~e ~ v~r ~Si c iu _ a•¦e.. sM ~nen »..~N ~ . + frKn ws e~ ~o • Pieoc~ h y~a NP't• Pi~oro~ ~vocial Horpltal D.O.A. ; U ~r r0~ w .~ul M111~t (Q{NlMt MAt1RD. IrtKf MAYIfR ~rN. ~M ~MM wr~ ~ { ..w: N,«~. ~Nasaaohtwtb `°r"'~' . U.B.A. „1D~r°~a~°i««•.~ Doaei~ Kn~o~?les ~ ~MM MC4lM ~ i,~. r M~w O~C L 1. OCCIMAI~ON ~rw ~w W~{.~~ ~b.~ wwN ~oM Or u.op a,.,,w.~s,.~+tu o~ L~~+o.v~sm ft~~~,I ~ ~ ~MMiO~, M~7 "~'~~p~Y~(rS ,~O~M FW r MwM ~ r~~1ifY~st J~FVw4 ~ ~lOi~ f1wi~W~t~ar f ~~FNK~ WOM ' I •wfro~+. 3AE?Kl-f1~ COIlMIY tm. tOw11. W IOCJ?110N Ww~ ~w~ l~f !'laacida 8t. Luoi~ Pa~t 8t. Lucie '"""jif~°' 2141 Kail Strsst ~ ~ IM IA 1• 1~~ IM . ~ IA - ~tiy r~t ua MOh~!-n4b[M ~rs+ rMU us~ ~ lhC~anlt Mo~'1C1~ u Naris 14~rtin , ~ W~NO ~OD~ElS ~sw~~ W~ r• Mo . cn w w.+. f~•w. ~ ; , Mr.. Doaeir Haacris ,h B.o. Bwc 4ooi Ft. Psrra•. na, 33~+3~ oG?1M wns tMllto ~r~ (tMf[~ a+l? ae uux r[~ U+t rw Nt w4 No al1 ..w...w e««. u....,. IL ; ~ c.: I~R.O/A~ !9 /3R,E s T ; ' ~~»M,.~. M.~. NRTER~D.sC~FIYDT/c HEf~RT D/SEA.SE ; ..a ~a ~ ~ ~..~«.n . : I ~'.a» ~ . ~ k~ ~ X~tRT/ON ~~mr~fr~.v~ iiv f/~s ys~~to ~ ~ Mtt ¦ Ot11[t f101w1Gwt COMD~t10Mf: cerwaw corrw»r a~mr M ww wu~ ro c..w ow~n... •.n ..n AYtO~ir r~Ef ~ea n.~«os ca. ~ ~n~ AO ~ MN~M ~w MNMn~N 4YM r O~ M~~r M } ~ ~.o..~.. r., ~u ~ ,2 Q 'p'"C~G~L/!~i L~D ~ ~/Y ~i ~"SEN ~ O~'~i~f~.E ti Ht ~ ~D - 3 ` ~ ~ ~ D M. ~ ~ c i ~ v.~ ~ i ~ r s~ w~ ew~e~ w., nc. ~~r ~i' ••r, stin. ~.cwe.. tOtwnou ~~wm w~ r~. ro.. a+. w ro.o. r.w ~ f/si9/ .(Eft /57.~l.~r i w.. • ~A~ /L T ST .c j ~ ~1/ICAI~{- ~OM~~ Mt tlY 4~ M~ ~~J YO 4f~ Y~ ~/~N YM OM ~ M/M MOt +nf~ M~lA/M OCCYYt~ M hKf. O+ M - i~n~Kuw, t~ .a.w~ M• w.~ ~ow •.w~ M.~. ~wow~ ~ 0~.w. ~o r Nv : ~~~N»M wy or ar aro+ueo~. ~ i j !N NCf~N~ ~W+ iN !h ~a /D/ ~N M~O M prrY~ WM " K,~ - a. ~ w~ a.y .o~ o~ N.~. wcwnn NOMOMiC/~ MY ~ ~ Ww~MO~~ M wr pN ~M/M M MM~O~~O~. w w O~rO~. wZ, U ~ Yl ~ON . N~~11 O(C1AN~ OM M MM W MR b wy 4OfM tt~q~ D~ M. TD ~ ~ M ~ ~ ~-I'1~ ITM M~wtl A M6N~ O~ \ I~OM~M. M~, ~/r~ ~ R~Q• Ilsiguss Im Me0• MS Lrw n~ - 7 ~.w ~e _c~.r.R. 70? Ii. 7tti: "~ibe'~ I~. Fl'a•: 3345~ dEMlt/qN. ~EMOvn! ~ii SOt't-s+st+C ~ u•. w a.~+ s~•n R~so~l ,a ~t Thoapson Ceneter~r Thcapsori (YirxlMa Co. } Nasa. , ~ ~YNfIAI MOME-NM~[ ANO ~OOf[Sf trq~. a~ r• wo.. i~t• y~~~e~ ~ {~Q ~ 4:~~ ,sR L. P3L Fume~asl HoM 8 1 . . Hx~?. . 3. ~61? iuN`EU~ ~Od- ~EGKt _S~c.~+~r~ - • i~e~ n ao~s~w iv~c G~, ~ w 10-4-'~'' { , ? Mnbr artify thb to M a trw •nd correct copy ot fhs Loui Re9istrsr't record o~ fik tn tha St, tuct~ County H~alth D~paN- m~nt et fon Plerce, Fbrids. (Wuning: Not valid unless raised ses! of the St. Lucl~ ~M ~ a ~ M County H~slth Ospartment is affix~d.~ ~u~ a ro,~~s~'~' ~ , • CLf.RK G«~~ p ~CUR ~ N. D. MIUER. M. D. vf Rif iE ` ~ Countp Hsalth Offic~r 8 Loc,al R istr~r 2 43 PM ' i _ G~ ~ s' ' ~ ! ~ ~ ~ j . OM~ Aputy Lxai Rwtst.,~ . ' ~ ~ ~ ~ ~ 3F~~51 ~ . . ; tf~ . : 6okK 269 fi84 ~ ~ .s