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HomeMy WebLinkAbout0914 ~ ~ 3~z~~o stat~ ot Flor~ds CERTIFICATE OF DEATN - Department ot 1lea11h ~nd Reh~biltUtiire i'ienices , • rt~tc ri~c No._ vt~r~4 s'rA'MSrics F L O R I D!l p~oisTaww•s NoA 14 TVPE OR PRINT OEClI~SlO-?~Iwf •nv w«~ usr S!t DAtt 01 OE~M ~••o..r., ~ ~ G'RAC~ GRU88S ~ Fen~t,Ce ~ J~LC~ 13~ ~ 1977 PERMANENT _ _ _ BLACK INK ~~CE ~M~q. M~OM. ~r14C~M w,.r. ,•~r v+cw ~.~u uw~~ ~ u. MrE d wtM ~~o+~.. w.. COUMtt d Olw1M ra . wce~. ~~~wa.. ..wu :oa w.~ ~ows .eu ~ 6602 , W~ute 81 , _T Jwie 3, 1890 S~, Luc.ie ~TI. 1pwN. O~tO~Ai1pN~ • N w~ Cw~ ~Wn NpjMTAI q OtNE~ NST --N ~a ~~Mi. GM irr~r a.y rwa r ' lNtr~ qf O~ MO , ~ F.t. P.i~ce yea „ ~z. P.ielice dlemo~i,i.at Hod pi.tue . - SiAtI O~ 41M ~ w~p~ w 1r ru~ CIiiZLN d WHA1 COtMTlr JWURItD. NEw!! W1l~D. SUhlirlKi S1'OVS! I N~~N. OA~ YpM W1~1 ~ ' , IncLi.ana__ ~ !!SA ~ M1O~iY"`.u°~ i~E° No~e ~fY~~~~fMK~ ~r~N Nq~M~ - _ _ _ ' w Nar SOCti~l S!C'~imr ?~l1~MI~ USY~I UCCiM~iK~ ~ati~aw a.o.. w« ~.~o .w~ a t40 OI NIS~+lSS O~ ~W1Ktir OC(YYlO M ~'Or~~f \M~, M M ytI\N I ' ~•~~•6~ „ 271-36-2595 Home ~akQJc Oturt Home • .~y....t~K•o.. •wtiuw ~yyp~~E...S/~iE COIM~~ C~1~. iOwN. OR IOCAI1pN w~ t.n trM ST~([( ~NO MM~~l~ ~wcr. m w ro ,N Ft.on,i,da „ S.t. luai.e F.t. P~.~cce ye4 2412 Shamnock Rd. IAI?Rt.-MAiNE .raa !•n MOTMf~-MAOfN NM~[ i+sr ~~w.~ „ Jamee young w Mcvc~ E, 1Nainea UOOWAM-N~M[ ru~M6 ~OO~tSS ~s.MU o~ w. cw. w w~... a~.w. ~r~ Thelmu C.~eve~Cand P. 0. Box 1022, F~, P~.ehce, ~~o~i.cfa 33450 c3j r~ut o~wm ww3 twuseo Nr[~ O~~ a+E c~use a~ ~~E ~p hl 1~1. wwo k ••w.~.. ~ ~ A NPnft~! OM4t ~w? M~M r-. M ~ h~ C.~u~c]io }iespirr_tory l~xre3t • • ~ y . O (OM~1~~OM~, ~ Co1~1~restive lIcxirt F'ailure ~w~tr O~N t~H M h) ~ "U ~ ~~YM~~~ ~11/~~ N~. M M. U~ COMMOMK~ O• {I~~IM~ ~~t fKNF ' ~n~N C~~N u1t p ~ C~fA ~/1~t ~ OM~ SK7M1/1CAN1 COM01t10NS+ co¦wwwt co-w~~n.w a«~r. ea ..or Nuw~ w c~+n~ ~u~r w. ~.n . w. NROrS~ M t[S .~r«.o~ co..- ~ hl p~ ~p1 MIIIf1 N~/IMr~MO (~YY ~w 'I o..~.~. ~w M 1~Cbt~f~-iD[~f- ~~ors. r~, r Npvr INJY~~ OCCYt~EO ~~rw~ w+w M~rwn ~r rur . w r.n n. ~n. ~ Ot VOIilYNr[O , 1A ~ M 1~1 ~MJ11~V A1 MiO~R MAC! O N +or. s.~., r~cw~•. IOC~hON ~ ~ snaa a~~• ~.o . a~. w ro~r. sr.re. ~~MCM nf M r01 ONKI M~O.. ~~C ~ MKA~ ~ ~ ~ ~ CEt~KKJ~T~ON- .o.w w• nu .o..r r~.e ~.s~ s.~. +~.i~n .~M or ~ ae oe H. ot~~M occveno w.~ n.~~, o.. ~w~fKUM: ~w` ~~M ~~h, ~w0. ~'O ti/ Mtf , 6 25 '17 ~O ? 13 77 1~ "7`f '"°7= 4o P a ....b....~.. r~ NtuN~ rq~ ~fq 11. 7t1 Ib M~o c.rr~s~ suno CE~lMKAiION-ME~KAI E11M1~t~ O!~-MOMI~~ o+ M~.f.~ v nn roN w w.w Nce«.n r~onw.~cw Mu ~~~w~nb~ W M qh uw/W ,w! w~rllnW~Or. r~ o~~•b•. tl~~ M~ ~1v~ n~w~ occr«~s a+ ~ ww w tit ro r uos~K~ n~ws . ff~ M 11~_ M Ct~iM~ER-rtMY~~r.~i w ?i«n - g~wt «yne d .~n~~-~-rw~'s~ O . -n•. w•. .i.~~ J.v. I lcuo, l:.i). r~ it i.~.ll. 1/15/ 17 ~ ¦uRM~G AOWESS-Cf1f~1r~ L e ~o~~~J~ Tm ~ .p`.~ - y~•n 7-~ r -V Gt7~ 17 '~"~ri .,trret rort°~'icrce ,~la. 3~•, ~CI ~I~UA~. (~MA~~~. ~[~bVAI fMETE~1 W C~lIMTO~Y--NAMF laA~iQ1~ (~n M q?r . ~~~~1 ~ ~ ~ry(M ~ . . Bu~ua.C m rz ~.c~ez Cu?~~:~; 1:=. _ F.t. p~.eh.ee ~~.o a~ - - ~ - - - 01?i~l~ . luHE HO 4r+p , s~ • • n r J ~,",~"'1~~Y' ~ ~'`a,c~`d-~'une~ut~Q0l~~me, 40P N. '7xli SZ'," P~•.'.P.ie~i.ee, 3345 V.S. #61Z IVrt~t OME ~ ~ ~INt uE4~S - ~(.ra~r~ o?q ~ect~vto ~oe~a ~w~snu p.,,. ~ns ,A tw ~ 1 ~'4-~ a. 7 ~ ' ~ . 3'726'~O r r cEO ~KO RE~ ofo - - ' 1 hs~+eby certify tfilt to be • true and tor~ect copY of the (,pu~ i~. ~IE COUNTY 1LA. . ReQiitret's record on file in 1he St. Lucie Count Health R~ER POITRAE _ Y Dei~~1- ftERK CIRCUIT COffRT 1r~f af Fort Pieres, Florida. 't ^~'a~ YrqtilEO _ (Wsrning; Not valid unless raised seal of the St. Luci~ 9 58 ~~t~ County Heaith Dspertmero is afFixed.) 1~ N. D. Mt LER, M. D. • County ai~h Officer a tocai Repistror ~ , fj~ . _ _ t•_ 0~ D~wty Loul Rev~~~•~, . . : . ~o~ 27~ P~E ~ 914 . ~ { . - } - _ - ,