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HomeMy WebLinkAbout0965 4 / _ _ _ . _ ---~s~ssr CERTIFlC' ~ OF DEATH ~ De~..~.K.~ ~i 14. ':.wl Rc6ab~4uN.~ Se..he~ frASt I~Lt h- - a....«va~~~a~n+ FLOKIDA ^ nn, oe ?uwr u. " I~tG1iTRAl1•! wo Ii3iL'.13M IN[ ~_Nµ~ .uu •w•~ u~~ SE7c QAtE Or OtAM .+ow+., nu ~ iB L~iJO[ IM ~ asm~ctaa ~ c : , Jt11y l, 1973 twt! .r.w. wwo. .w~w +~wr. R~rGrty-~up ~••w. ~.e.. ww. ~ r. owt[ a WttM ~.aw.. My COU~+111 a OfwM ' ~.c. ~wcrr~ ~1~11tB /iw+~~ •w. rn .oM~ w~ . k , riar. 21 1902 St. Luci ~ 6 F 02 . OwM. t ..wt cn ~~.n K OR OIMEt 1ai ~r .a r tir~. «w u~u+ ..r w~w~ ~ wtr. r~~ M wo ' h "r'i.. Y1~SOB h YPS F~t. P1P.Y'O@ MP1i1dL"Idl ' - STwTE OF WTM ~ r ro~ r~.w.., w..u 1~tW W w~wi COUwitt rwtEO. ?+EVEa rwrEO. SIIMr~+G i1'0115E ~ r.r~. ww r.ra. .w~ ~ ww~.~ wEO. ~wc+r. q.«K. ~ Wisoonsin • USA ~Sarr~ie~ Graoe ~MM M4~M~ ~1~. r MM~ ~lY ~~ylY~ MW~ft YSIIAI OCCW~f1~1~ ~4M lM p rpa ~OM ~11rn0 ~OM W Ra'b p l~I.fm ' ~~ww~t ~•w 321~D~rJ024 ,raa w. m. r.ara ~ ,a p~ ~ESrDlNU~S/AI[ COYMt CRt. 7OW1'I. OR IOCATION /~MM CF ~r/~ fi~Eli AlrO iwtrr ns w ro Flaac'~da ,o St.Luci~e 14 F't. Pierce ,k Yes 3201 S. 23rd St. /AiNE!-N~Y[ ~rN r~M~ uM MOTIEl~~MpEN NAAIE I~YT ~MK~ rM ~s ~ k ~MW~M1Nrt-~+M~E rWNG QDWESS ~wwt O~ Lr~. Me-. M p IO~w. ww. tr~ ,h Graoe Augl~rt 3201 S. 23rd St. Ft. Pierae Flarida 33430 ~ rw~T ~ outN ww3 Cwseo ~r~ (trrtc~ a++ir a+[ twus[ rt~ u+E ip Ml Pl~ ~ kA u+: o ai.:~+.iw. ~ ` / ~ a~ dY0/~rlr y Af/3S / h cw«ne+~, a ..w, ...c. s..~ .~u w ~ M11 . • • ~ ~~yt,~~~ C~11~f /M. M q. p Y~ fY+MOMK~ 0/~ ~ ~I~hr~ ~y 11r~~ Q C~~N Wl kl ~wtt OTNt~ S~GrarlCwwT CONW~~O?~4. ca.ww.s co.rw~wro ro rnr w~ ~.w ~..w~ ~o uw ~w r.w •~r AU~OK~ M 1/ES r~~~ n.~~..es ca.- ~~lf W+0/ MNN~ r Nt~~rwrN GWff M NY~ b ~ M ~ y..rwtii- p ~ . ra++w. rs, ~w ~ tiOw uW~t OCCY~lEO ~~re~ w.ww~ a..w~? w~.n ~ e~ ?.r w~r. ~ ~ KiOf. ~ tsr~.~vl1 . ~ Oo• !U 7M. M. tY E ~WJYIt~I wt wOR+t f1ACE Of ~alN~1l.~ ..or. ~w. ~..ur. ..can. lOGi1p+ ~ w~a e~ Lr.~. wo.. cw~ e~ ~O~w. ww ~ ~~~ean n~ a re~ ann wo..~~t_ ~wt.n. f ~ i CC[ti~C/~TqH- .a.d M~ nu .o.... r~ n.. ..r us~ ~.....i.a ...w ar .»/M ..a .r+ ~r ot~n~ OCtw~es .r ww nw. w w~ ~O~r Yf AY ~Or1 11A~ M~ ~ I IwYlKUrin jO - ~~DO~1 Nw. ~w~. 4 M MY . n. ; 3 o w ~ :,~..,....o.. tw - ~ - I ~ CEtilKwiqN-rfWCM E1AlrY~ft CO[On[t. O~ M M4~ W M~ .oY. a w.r M~r~w r.~ k Iu~w~MM O~ M O~ ~y/O~ t1~ Ml1hG~~~. r r pw~pw. ~O~ M~ AY w011~ ` d l' H~t~ OCpWt~ O~ M MA IN ~O M 4Me,M pM~. [ r~ (1 M f7'? ' M ~ ~E~T~/IER-Myy( ~ w. A ~qr~ p hr O~+o~*~. N~. tual 71~ /~I '.Y~// ` ~k' wWNG wDO~Eii-C[tnlrtl ~rrn ~ r.•A t ww t ~ Il~ ~ ~ P J/~ ~ Npµ. (SEMA~qN, ~Elypyµ TEft M CJE/~~ IOCA i 4n p q~w wn ~ wtr~ ~ ' Burial Ft. Pierce c~p Ft. Pi,[~x~oe Floritla N~July ~1973 ~ ~~~BAIF~ F'U~'F3~L K~ 9~Y~~i°~: ~~t~i'~t:,~FE:~`"ierce, Florida 33450 v. s. sb 3Y • srG+~? c~ s+ca,rwc . .acavu ww .ea~srw Rw.19T0 ~ ~~csri[ Q~!/~st.~ 2,. ~ o f ~Eo ANO ~EaoROC~ WCIE C011NTY FL . ~ , - Il66ER p01TRA5 CIERK CIRCUIT C40Rt yEctFIED y, ~ ~UN 7 I 43 PM ~~T ~ ~ n«+~by owr fi? rha ro b. s m,. and corr.a oopy of m. ~ ~cqistrefs reoord on file in tMw St. luck Gcunty H~aith Dopsrt- ;-s_ ~ tnMt ~t Fort PiMU. Fb?ida. 3{X7e~~ ' _~e ~ . ~>'~•x; r~+~ l ~ op ~6__ ~ (yysrning: Not v61~d vnless raised seal of th~ 5~. L:xJ~ v i: ~ Counry Hqslth Depsnment is sffixd.) _ . a =yY f ~ N. D. MlllQt. M. D. ~ ~ 4- - : ~ Hwl'th Offiur d~ pistrst - - s,-, ~ ~ ~ iti~,.•~,~~ ~ ~ y- ~ y ` . - p~,~ p~qAy l,ocal R~oKnK • ~ ' . goax 26~ ~~E 962 ~