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HomeMy WebLinkAbout0822 ~ 3'~2611 ~ ~ ~ st,t~ oc Flori~ta CEi< i IFICATE OF DEATH Ikpart~~~••nl o[ Health anJ Heh~bilitali~e Senicea *TATE n~c No. _ _ _ _ _ _ V1TAL STATISTIC3 ' F L O A I D A p~G~aTpAR 3.+o `~~2 TVPE OH PRINT ~~~M~tO-NM~! ~ . ~~fr St¦ D~~E O~ Ot~IN • •o~~+. o... ~ ~ , Gj~CE - - LIAlDN0~1 Fq~n.~~ ~ 1u.1~ 10~ 1971 PEHMANENT BLACK INK uC! ..•n. ~~ew. ..uK•» •GE - uu w~~•. . ~w ~vw~~ ~T?.. _ Cw~t Or ~uM ...o..~.. w. ~COUHt~ p Of~tN ~t( ~ W~N~ ~ ~~~~r~~t .r~~~~~ ~Ot i M.~ ~ ~OY~t .~I ~ G602 ' _ Wlu.te _I,. 13 ' 1" ~ _.1__~~ ~~04 S~t. Luc.i.e. CI?t, fOMM. O~ laAIIQH Q~~A~N ~~f»~ tM ?I~~MAI a OtM(~ H IIT~Ji ~-N ~r ~.pr ~u I~~V~. G~~! f~Ml~ ~`O wwN~~. ~ Vf(M~ tlf M r0 ~ ~x. v.~~~e y~ „~z. P.ieJtce Ate~non.i~t.f Hobp~.ta.~ _ , . - I__'~ M~~. GM Y~~MM W~ 1 SIAIE OI ~NM ~ N r0~ w r.~~ Uf11[N p w?11~1 COtN1~1 ~MAl~KO. NfrER MA~R~lO. ~~ry~K S~~E ' tOwN• ~ WIOOMI[D. WK~lC( ~ Wtr~ ~ ..,a.~. . Madeachu.e ette . USA Mcwr,cecp t~~~.P~i.ctm . G, I.tndfio~m r.~UNC~~N~ ' ' ' ."'"""..L__'_"""'._""_"_" ,..~e r a•n~ SOC~~I StC'~M~ MMyl~ USU.iI O[CtM~1~0?+ ~v.~ ~w o~ ~on wa ewwo +oar w ta+0 d MlSMSS W MDVSt~~ occ.nu r .or.+c ~~r~. t.e.. r N..~ro ~ 'w{h~Nqr.GM ,r 121-22-3278 u. Nome AktFeh Ot~~?t Nome ~~YNKfN~W~ O.,,- •eriswr HS~C[NCE-SIA?( COIM~t C7it. IOwH.O~ IOCAIIp~ ww~ (wv tr~M SI~III A?Ib ?Nl~t~ .~u.(.(~/1 D~I.~Ve"_ ~~~..~~NO•«.p Rt. 1 BoX 365 ~ t""-~' 14 ~ f.t. P.iehce MiNtf -N.Wt nnt ryp~ uv MOtMt~-_~ul+(N Nu~[ rrN w~M~ u~~ Gan~~.etd loaeph Gn.i.f,Cd V.i.eYa E.the.f 1?Ii,P,~i.n ~MOW~wt-~uMf rulwG ~WDHSS .~m~~ w~ r• +o . cw. w ro~•., ~~.w. ~M~ Wi.Y,ei.am L.i.?idhofm ,n Rt.. 1 8ox 365 F#. P.i~cce FC 3450 1 J .At' t ~~1 ~~W +M 1 vY c~ a~m w~! C~usto ~r_ ~[Nru aa• oa[ c•vsE K~ i~+E ~o+ NL A1 ~ kN u~.a+ o«w~ ~r w.rr ~ N -~Ti zirtT - GPR~?~/)~ l~RRES T r: tOrNt~Or?. ~r ~~w, Y ~r~t~ 0~~~ ~~N t0 I~I ~rr~M•tf c~rt~ Nl, - - - p fun~~ tw1 Yr~K M q• p~~ ~ CMf~OMKt d p~M ~~~N t~~t ' ~RT~=i~~~~<c~.r'k~ri~~~iJFr__L1s~~s~ - • OtN[~ S~C,wr1C~wI CO?~OrtrONS [o.~wo~s co.~r~M~+o w M.~. M w. ww~~ .o c.ru aM. ~ y~ ~~UfO?St M ~tS ~u~ n..~~..o~ cw r. nt o~ ~O~ W Hii~ Nr~mr..o tNSt _ "/?//A / 7 y / /1 t. _F ) h/ ~w M•.M?M ~CZi01y~. ~i0t ~i-- ~T1~rl~ i~0~~. M~. r~.~~ . ~ MOW IN1U!• OCCYf~fO ~~rry~ r.'uM w.w~. ~ o~ r•n w. ~K~Of, a va~twrwo ~ ~/t- ~ rnv~~h ~~N~~ ~3 Y[~U~fj/~/?/~ . ~ 1~'<<LrllRaL ~ 7-~ 7 7 M,~~~ c U~v r~• ~ f~: ~,~'r c~~it IN1U~t At WQlR hAC~ O~ NlIK1 K~. f~M~~, r~[W~~. IOCAf10M . H~ M~•• +O . Cm M to.r. s~~q r ~i ~~rK~n ti~ o~ +o ~ ow~n M!a .~t ~ fnc~n ~ w. ~ ~ - ~ 1: f - I ~l r' ; ~ r / CtffMKl~i~- .an+ nu .a.w •~u ui. s.~ r:.N u~n w. ~»iew ~o~ wr o~•~~ Occuuto r..a~. o- m ; ~ ~M\fK1~M: 1Q ~O~M H• 1~Y W~~ ~Ih~ M~M ~wp~h~ / O~h. ~i+0. 4 M Mt~ ~ ~ ~~W~~ M~ d r~ ~MO~11001. M n. e~n..~..~. 7n 't~~ n~ n. w~ w wq cww~s~ u.w. -1-------- ~ - - - - - ~ C(~tMK/~i~pr~--?rEDKAI E~wMw[R OR COfO?it~ o-. ~.s.~ w~r wu• a w.w. ..r Nc~a.w •.t r~o~o~na~~ N.~ o,. .oe. .„.iw n.~c..o.,, o...~o~.. ~ J ~ .a.~. .o,,. oc • ~.w • wn. ~•uo / Cf- ~ L"--- r'Sl~.r7 _ ~f~~I~/`f~._ r:Cf~__Ml1d~~;--------~_!~ Ms~»---1 --77 Ct~t~t~l~-?+M~t ~,m o~ •nr ~ S~G++~1Wt r` ~ a~N~ a•••y~ ~ b~i[ SK,?a(U ~+w~. e... . _ ~ ~i ~ L ' L ~ D~ ~ ~ u-t~~i. ~ Y Ik ~ 'Z- ' ».--~-~<=L_ ~ ~_.~~-_~_A1-1-~v~1~------_.~C~~----~~ C,a--- - - - MAIIMK'i ~OpE7S-CfR?IfK1 ?~w~• o~ e.o ~~n w t s..w r~. ~ - - ' t-~.- - ~~r' , ~ i, - L ~ t .~tc,_ 1"h~~ ~3Y.s-U- ~uhwl. C~E~utqM. KMOV~1 ttWttn o~ c~ENUrW~_ N.iwt ~loC~~~p+ o~ .o~« v.~~ ~ a!K r~ ~ E 8un,i.a.e H.i,~Qcne~.t Nem. Gd~~a . ; F.t. P~,~ce FCon,ida--------- ~ . . . ~-ruufir70~OMtSS .fu~u~o~~rs.wd co.o~~o..~~un.~•r~--- OATE - . . ~ _ ~ ~ ?U?~t R~i MO ,y J 1~~~97~ &LC~ FunQha.C Hom~ 901 N. 7.th S~t. ~~t. P.~~hce FP. 33450 ~ - - - . o~n ucn.~o ioc.~ nwsru~ vs. #et2 iwt i -src?+~ ~tcai~rMn -sN +,run ~ ~~C/ rw .TUI l 2 1977 f R~r. ~/7B ~ Jw /`c~ N.1 ~~-IC~`/1+ i B ~ ~ ~ . § I heroby aertity thls to be s true and correct copy ot the Lpc~~ ~ Registrers record on file in the St. lucis County Hea(th ~epaA- m~nt ~f Fort Pierce, Florida. (Wsrning: Not valid unless raised seal of the St. luci~ ~ County HeaUh Deparlment it effixed.) ~ ~ p . - . ~ N. A. Mll R, M. D. ~ Gounty H Ith Officer d. ocel Reg~strer _ ~ 7 / ~ . 'h co~~ ~ o.~. o~,rv ~«.i R~,~..,, z. ~'~t~r a.. ~ R~CER i~QrtfuS ~ CLrF.'. C'~iCU1T CC'J?j ~ ' . r: 'FtEb ao~z71 P,~ ~ Ju~ 20 I 46 PN 3~2611 ~ _z _