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HomeMy WebLinkAbout0653 3~'9;50s ~ ~ , ~ stau ot Rlo~da CERTIFICATE OF DEATH ~i Osp~rtnNat o( H~alth ~od R~Aabititatirs Rer~iou fTAT[ ~ILt NO. , YLTAL STATISTICB ' F L 0.81 D~ . ~~a~s.~~~•s ko 408 ' TrPE OR MINT • • ~•••u 1 [ A r.. .•u ~ rERMANENT ~ `I~~~ F~ EZl~Ot.~ ~ Kdl@ ~~TI~ iZ~ 1~ ~ SIACK INK ~ACE ww. rN~o. wruw w~~w. w6E-~~u aw~ ~ CAtE d Ml1N ~naww. N~. couM?. a a•n+ ~ ~K. ~MK~~ ~ ~W~~ ~W Mq wM~ W. 6602 ~ ~t'~' . ~~P~u 1912 St. I,ucis , t .+w cw ~y ¦a r ewn. Mw wn+ w «ww ~ , wcr. ns M w . ,~ForE P3eros yes N Fort Pierce Neaorial Hoapital . ~ f1Ai! 01 ~N1N ~ r~N~ ~ w~w1 [N Ot w1Mt MARMtO. ~lrH MA~lb. 3~0116! u ww~. ~1 w~ew wr~ ~ .,.r,....,~., . Toxa `'°w"'~ ~ U.S.A. M1O~?~~~tOi""" „ _Arlene Raisler .rw «ww s'~cw s[Ciim ~iiwiei'° uswTOt'cvi~t~oN ~«w aw a.o..or wr.w reM a wo a wsr~u w ~a+sm ~..a. • ~w. roww M« r.n~ ~ „393'~9'30~?1 ,s. `~nB~AAer FWD Auto Go. ~esioena-s~• cou~r rn,r. roM++. w ~ou?na+ c.. ~.w ~i~eii'~i~"'ww'~1 . ~ wc.. .e• « ro N, N1sCOrisixl 1laupe?os C1Lc?tonville ~N- yes N,arj W. 13th. 3t7c~eet 4f1~!-q~M! MM ~~MY uN MW/N-MA4[M lMMI ~~V wN~~ W~ ~ „ Louis C. Slliott N Laura Gluick ~ w??.~a ~uoo.EU u,..u w.... .b., a•. o..o.r, u... ~ „~Krs. Arleoe Slliott „~85 W. 13th. Street, Clintonville, Yisc.y~929 ; _ ot~?u~ wns t~q[o nr, ~crate a+is a+r aust ae t~+e ?a NL Al yo kq war.a. aw.......w ' ~ . w CA v ~e ~ ~?"i~~ ; cew«Me+i N~.w • C~~ 1 C ~'v`~v!`~G_ . . ~Ntw ~a~i t~w ~ ~ M ...rwa c•~u ~ ww . e~ a~ • te. a= • , ~R i~~w'i"s~wi uN ~ l ~ p~/4/~• - «y ..'7~+.. a'~ ,~-?7 -t~t.f O-~G.rc.l~r ~l G ~ M!1 r. oA~N 310Nw1[~Nt COMOR10Mf. cor~ cw~~wr.~ ~e w~+ w~ «a ru~a a c.w ~«w w~ ~ w MRO?Sr • rES ~n« Nw~.N. ca.- 1 N~ ~xY/ ~rM MbM1Mw~s CNN . . 1* q M~i ~~M• ~u~ . NOw 1NJfMt OCCYMEO rarw a~.w~? rr ~w ~ w?w r, Ar n ~ ~ i~ OL ilr. INJWr AT M'O~ u wo~l. ~q~n. ?~tlow. tOCA110N ~ NMp e~ ~.t~. wo., dA M ~ew~. M~M ~ ~ 1 M~tlti R~ O~ y~ MN.. K. 11rK~ 1 - . ~ ~ ~ CMIhG~T10N- na~+ w.~ .o.rw . .w ~.r us. p.r ~..nw .~w~ a. ~~+/M.a .r. r«pw ottwe? •..r n.n. a. w - hIt1KMM' TO r0~ Mf AY ~O/~ MIN Mv I~OM1 ~Y~. Yy. ~O 1~ ~IN Or w awru~a, ~N ~ ~A~yM /N ~7q ~O ~t tHqtOl-W~. . lla ~ec[~N~ ~w~~ ~L _L_L~.. !N i1~ fN 1M - CE~iOKATqN-MEWCAi [1AMNE -~R`CO~NE~: a. wy w~f or w~ ~ a M•w wr Nc :w wo+o~w.cw ~w ~ ttaruwa+ O~ we ~ow w/a~ w~ wMN4~wpw, r w orr~o~~. l ryr~ wD(y~~ D Mu~ Otio~rM br /r Mt1 ~M N~ b w~ tliMt4~ Y~tn. 6 1 0o M~ ? • 1! r oo ` M ~~~mad~ Rashid1 M.D. „ ...i %`~r ~ „ 7 1 ~ ??M~.~~ w`.+a ~oo.e~i O ~ a..... «o. a..o... M r,i ww. orruaaN, ~t.wna en w a~w?ro~v-w,w~ ~ocw o~ o..o.~. ww ....c..~ Reaoval ~ Gracela~n~Q Ce~etery ~,Qeatoaville(Waupe?ca Co.} Yisc. i.o~Mr. wu. WNlR4l ~IOME-iwME N+D MOnESS ~ sma w~~•..o.. cw~ a~o.r. u~w. t+ ~ ~ • TiLlC~9 ~r n.R I. - B Ftiineral xose 8 16 s. Fed. H, ~ qw:~s ~ ~ tn Ju1 ~1A 1977 ~ ' 1 M~eby aKtify thk ro bs a trus Md oorrect copy ai th~ Lu~c~~ ' . Rpistrsrs recard o~ fila M the St. lucis County Heslth Dep~R. ~ pwnt at Fort Pierce, Fforida. (Wwni~q: Not valld ~+less raised seal of ths St. luci~ , : Cotir~ty H~aUh Ospartmsnt is affix~d.) ` . , f N. D. MItIER, M. ~ , Counq? alth Officer 6(,pcai Registre~ , - . 1 lc.~...s~ dk- . a» D~wfY tou! Reot~•.,K . f~~ ~ ~ C~ ~OCE ~~~s ERK CIRCUIT COURT ~R4 VERtf1~0 ~ ~ ~ sa pM'~ - 3~'45p6 eooK z~ ~c~ 65~ . _ ~ _ _ , . : ~t;~-~ ' - - - - -