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HomeMy WebLinkAbout0825 •,cv1,s ~ FllEO AMp REcpROEO iT. ~UCIE COUNTr Ft~. ~lE KCC RCUIT COURT rr, 1~41i1E0 Ju~ 20 I 4s PH'~1 3'7~61;~ ~ . . s Statr. n[ Ftor'tds~ CERTIFICATE OF DEATH Department uf llr.xlth and Rehxl,ilitutive Servicrz trwTe t~Lt no._-~._~ vrrnt. s.~~; ::sr:~ ~s F L O R I D A w~cisTnwp•s No TvPE OR PR~MT otCtwlto- ww.,r SEi O~fE W flE~~N •~c.+*w, e.~, ~tu. PERMANENT ' E"LRA---.-{~hLN)----L~vYU : Male July 11~ 197? BLACK INK ~CE ..n~ ~e..~o. .wr.u.. -r"~GE ~u«:,r? ~ •tu t.•..te~ ~ e.. ~M1E O~ ~~~iN ~.owrw_ s~r. ~Cp~~i~ Oi OEwin uc ~ snc~~~ ~ ~ f~ n~o.. ..~•~s, .~o~ o.¦s t...w~t r.. ~ 1 , ~ lJhite 67 i~. : ~~12-21-1909 Indian River TT - _~~_--1-----~- - CR~.10'~'N OR IOCAhON Of O[Ai~~ "«?n~ c~n wns ~NOSP11Al L~R OTHER NSlif{JiION-N~M~ ~n ~.p~ w af.y~, anetr •.e ..uw~~ ~ ~ ~ ur. .es o~ .w , n Vero__i3each_. _ _ Yes f,~..Indian_River Memorial_Hospital_ - i- . S1AIf Uf 6~NM ~ o no~ ~w v~. ~CIAZEN (M W..wt CU:M+AIlY , M~tR~EO. t+Fvtt MARInfR ~S11R~1vNG SrOUSE ~ w~.q. G+r~ r~o~~ wrt i co~..n. ~ w~UOWfD. O1vQ~CE ~ vttr~ . ~+~.,„•p~• ~ iC~ntucky U.S.A. ~larri~c~ Ida Matilda Cris~ ..~~~~«~.+~o - _ - - - - - - - - - , a.,,, SOCW ~!C'IY~TY ? ~~Met~ 'USVAI OCCUPA'KtN,e~+..woo. .w. w..e w.~»e ..~s~ a (RWp pf WSWESSOR ~NDUS~Rr occ~nw ~w ~ ~+ea~~w e.r. ~e•~.eo ~ i „ 4C)t)-U)-6799 Rc~tired Salesm~in ( Betsv Ross Bakeries wa.. ~ -----i-- - ti~? o.. - - ' RESWfKU-.S/A!! ~COUNiY ~~IIY, 1QWN OR 1(XAYa7N ±-~~+s.e~ un'~rm SI~EET MIO NUMlEf t---' ' { ~ v~tu, .n o+ w ~ ,Mrloric~a 1~„St. Lucie Hart Pit~rce No ,,,,Kt.#S, Box 887 ?A1MEl--NAMf ~~.i.~ .~.,oa~ _ ~.s~ TMOINER-tiurDfNN~ME rws~ ~oa• uf~ „ LT ~ EY ~30YD 1,~ 1?IAR Y ELLE.'V SM I TH INIOMtANI ~NMt[ MwKfNG AOGRESS ~s~n~~ W~~ o ao. c~n d ro..., au~~. ir~ ~ ~ ?~Srs. Ida ~t. 1~~ d ~inRi:.#5 Box 887 Fort Pierce Fla. 33450 . ~ART I pEAM WAS CAUS[~ !t1(E~ Of~IY ONF UUSE ?Et lNE tO~ o, jA). AND [ t~~~~~~~ } ! ) ( 11 ~irr~Iw o..e~~ ..w, a.?w - N wuo.n c•us~ ~ - - ~.'t /'i 4'_ /1 T C'/; ~ •C ~ Y r ' 6L•i~b,'~i'TS~S'~i~Zi o . CowM~ort, t? uN, i _ ~rwKw 6.~e ¦~f~ ro f?1 t1ll"f ~A/(,'1~~1~/N~/(~ ~('Q IMW01~7/ C~Nf~ 101, 1~~IIM(~ IY~ lN~~4 a'+ TO..~t ~1 ~(VM~lp1ANC1 W lflw4 <~Vf~ ~~tt <<?__~i f-;;~_~__s_~-!°_< ft~ C:~ .'c/cc~ t~'•},[~<<~f~_~r [p/ ~ ~ ?Att 1l Ol11ER SKsNM1CANi COT~D1t101~15- cowano..l tpn~yvn~ q e~.rM w~ Mo~ uury0 ro urS~ 4~tw w~ ru~ ~ N~ ~~Y ~i ~f5 w~~r /IMOING~ COH• ` ~t\f M MO~ ~+WMD 1~ M11~r~w.wl. C~Vti l~ O~ G~~{M ~ ~!if~ l: - - ~w y0 ,iw - p..pn~,,3~,1 ~C06WT. SiN~~At O~t ~Uwt[ Ai eax1AY ~.~.n., o.•, ~e•~. ;iKri~ft ~_-~-~;HU'~Y INIUR~ OCCUtlEO ~luri~ w~wt o~ .wu~r ~w r.~t ~ o~ r•~~ r~. ~ .ea~ H',,a~uGLE. O~ tlOflta41W0 1 ~ I~I i'.~+a.1f) , ~ I 9YO ' TM )k My)Y IN/VfY AT wOftR rLACE d n~}t/lv.r rp..~ srKer, r,t.u~ t0."wAON ~ arqu w~.~ • ro . em m ror.., sr.q ~ ~ s~u»r nti w w~ a.~er wn-: . i~e . srec~n ~ ~ !h ( 7M : n7 ~i CERt1iK~t~On- .w•w • o.• n.~ , ..o..u. o.. .e.. ~...o utr a... w../~~~ u.~ o.~ . eo/ao ~+os .nr ,M Of~iM OCCYt~lO nn n..t. a. w ~M~SKuH: i •o.... w• nu woe .rnr a.•,~ .nwa. o.if. ...a, •o sr m~ O~ rr aNp..~fOG1. D.p ~ ~n~..oeo rr~ ~ ~O -7 Z ) / ~~t . A ~ fl~ wc~.~m uor ~ ~ ~ y71~ / '--~C ~--`-1. 7 ~ ~ 77 711 ~ tif~~ )b7: ~~~yM ~o n.e c•~un~ ft.:to CffSrtKaT~:~7--MED1CAl E~w~uNtR Ot CORI~!!R o.. ~•~~a o. ~+e .+.v• . w.r+ ~ rw~T ~ oK~~~, r~s rv~.o.~~.ceo oe.o~ ~ - ~~~~.~r~+ G~ rwl ~GOs ..i0/W rw ,..•Ift+:..ehw, rr 4rw.~4~-. wd~~w oi~ e~~• .q~i c W~~MU:(1~1~OC+~MO~fl~w09Nf.ltM<~YSf.l~t~~ifY_.______._ ~ _ ! m M+llf M e CtfT01El--w~Mf ~m~ w r~.•~. TSK'~a U~F Y w~.~~ or n+u Tb~tE S1GM0 .ro+n.. w.. •ea~~ . ; _ r~ Vi~ tor Ra~3r i~uez ~i .n . .n' ;_•L' K`-~~Ltr~ ~c( i) ~ 2 > ~ _ - - A~A4NVG wUG~[SS --CtRUl~A t n~• ~w . , ---~i.~ _ or..~-_ s~.•e t.r g J~ ~ 23OO Sth . Av~~nu~, ;/c~ro` f~e~-ach, ~lorida 3296U ~ EU91JLL. CCEMJ~Idi?i, f~M~:YAl ~EMlifif Cs. CL4/AAI~~Y - 1;1•.~j ~C4HON C.n pr ft.te ~ v~un , i - 77 I:~. - I'i~r.c~i~ C~.mt>±~~r~., For.t_PieYCe,. Florid~ t3uri~~l f ror ; . - - - - - _ . . C ktE r~r..w. c.r. .t.~ ~ ~Uitsk V NUr~E - - .a.: <•J:: th=.~: ~ ~ . s:rerr : ~ ~ ~ O «c. . ~n~ tH r4sw. 7~~4, J~~'. i` Jufl~ 13, 197? ~,;.H <;r t Pi ~~rc.e l~ un~r. al l~lon~e , lU6 So .4th .St .,Ft .Pierc~, la ~ 1.' i ~btT II;NEi,t j~,'t(iGR~-~/Gvi!{,'tl ~ : ~ A(:.~~rc.•,~~.....•ar, . o~.t ~~CtirlD t4C.~l ~IG1~s1~•i F•ev. 7/lb 1S! l, i ? 7'-. ~1~^'1 i,,t._~. ~ T4! ~~(.l lV 1~~ ~ J~>77 i.~.~^ ~ "I N~PEs3Y CER'CI~Y TN~,A~OVE ?~J £c A T^!.~ t'.~;~ C^~t^~~T COPY OF 7NE LQCAL ?2~G`_S'"`2I1R'S RECORD ON ~Il~ Ih` 7~1~_'I~?D~A~1 RI~~~R CQ:i':TY ':::11±_!,' L~lIT AT V~R4 BEACy, FL02IDA." ~ ~ " TN:S IS NOT YA! ID l1i~~ ESS T~1£ R1IISED SEA~ ~0~ T'~c ' = INUTAl; RIVfE~ COUNTY:N£ALTK_~tfl~IT IS A~~?XCD. ~ . - ~c ~ C~~INT N r N DI ~CTOR, R G STRI'~? , ~ ~ . ~ - . ~ > ~ ; : -f,c'-r~P~ ~ . ~ . . . . ..'~'r ; : ~ ao~ z~~ P~ 8z5 ~~u _ ~ .~~w~ :~~N