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HomeMy WebLinkAbout0397 . , r ~ S~~~g~~~~~ ' ~6GE~ p3~'a~?s nrcaan vER n~0 ~vu-, ~a~s SEP 30 11 to AH'11 ~ ' . Pal Bea,ch Couiity Hea' h Department ~ CERTIt`ICATE OF DEATH D.~w.w~ d Ik.i~l~ .MI Rr1..i~N~.u.r Sr..k.. 1TAT[ /IL[ NO. j ~w~~w ~ r~w~.~~r F L O A I D 1l lrtt, O~ ~R1N1 IM ~"r"~'R'~~~'~^'~ RCGItTRAw•f NO. H~MANtNI INU ~A~~Nµt[ ~~~t~ w~~ ~~f~ SEI IWAI00[ NI SEX OAT! Of OEAM ~~OMrn, N~, ~ K~'~'~ ~ HO~I~IAN WF•LSH Jr ~ t1ALF, ~ Dec~mU~r 2 1 6 RACE •nrw. wow. •w~K.w www, ~GE-~.s. wae ~ n.~ IFO~~ ~ M~ DATE Oi NRM ~.~o~+rr. ~ar. COIJNit Oi OEATN ~ uc. ~ vRrr ~ ~ a~w.. ~ n.~s ~ ~ws. ~.n wows w~. a•~ ~ . Wh itt~ w. 63 ~ w ~ ~~zY 1? 1913 P.~] r~ B~ach i ~ O'O . iOWN. OR lOC'Af10M-~OfAM wfr~ cwe ~snf ?epSllfl~! O! O~f NSiliUT10N-N rq w ~nM~. 6~! f~A1~ ~M wrMH ~ ' ~ MfCrr ~y q MO t „ iKest Palm Beach Yes „ Good Samaritan llosni.tal ~ STATE OF MRiN ~ ~ wo~ r. v s~., ,~.~u qfl2[N Of w11AT COUM1~~ ~rAlt[O. lIEVE! oMWEp, SUfVMNG SK)USE ~r .~e, oM r?«w ~w+e ~ tow+n ~ ~ sncr~ ~ v+~u w~...r. , Pennsylvania , U. S. A. ~`arr~° NoYma Mundis U+rN- M N~M SOC~AI SECU~IIY NUWER USUAI OCCWAl10N ~ow~ aw p~ot ~pq w~wM wo~t o~ ~crro w wu+~u oi .+ousnr ~ C:~Y~M~ M ~OSM6 lrf. Mw M M~MM 1 „ 175-10-n989 Proprietor pelsh!s Marina f •wntaw. ~ESIDENCE-SIAfE COUNiY CRT. TOvN1. OR IOCAt10N ~+w~ Cw /ww~ ST~EEi !N/M~E f Lru.~. ~ vtcrr nf w ro ~ ~..Florida .,p Martin Jensen Beach No ,M Reacan 21, Apt. F. - 5 : ~Ai1~t-f/AMf ~aft ny~u usr M0114R-MA~EN N~ME ~wsr ~wM! uW ,s Norman Welsh, Sr ~ Florence Householder . IN'OWA?rt-HAME ru?~ING AoO~ESi une„ w ao.. es. w w..., ~•w. ~r~ Nornia We1sh Reacon 21, Ap~t. Cy-5, Jensen Beach~ Florida 3?li57 , r~rt oEwm wns C~usEO ~r: (ENr~~ a+tr a+E uusE rEt ~rt rot IeL AL ~ kN wrnw o~nn ur M~w~ 11 ..~rw c.vu ~d~~cu:~c..~,,~_ .a~..s-~.~- k-k~4.- ~ ~ ~ • . . . , COMNt1OM1. ~M, C j ~ ~ ~ .?'3C~t~~. . ~w~(w 6~~~ ~H! 10 h) VYK Irr~~uq C~Yf~ IY. ~Yt !O. O~ ~3 n Cp+f~OMK! M: ft~t/M0 l~f •M~N- aws c•vu uu (cl i IAfJ a. OI1~R SKfNO1CMIT CO~/D1110NS: to~oys cbwMMwrO ~o M~tr wr iwt ~euw~ ro tµ3e 6n~w w~~n ~ N~ M110Kr / 11E5 rue ~~M~~w6s eor, 1 i~f O~ NO? Y~l~t1 w~tR~MN~O 4q~ ' I M~b~Msl KG~OEl1~, SUUDE OA ~~ONM, Yt,....~ ~w No *~t~1M i. _ K{OEi OR IROlt!lMUlEO MOW IN/U~9 OCCUtlED ~ t~q~ wnMt p~wwrt~ w?ut ~ o~ ~ur wr q~ ~ ~ ci.p - iw 7M M. 7M. ~ IW11R? wT MfORR rtACE Of N1U~.~ ¦or. r.ur, ~~non. IOCAf10N ~ fnen a~ c~. Mo.. an o~ ~ww, uw.e ~ r ~wan ns w ~.o~ ow~a r~a..~~c ~vacrr~ # ~ ~ ~ . ~[1T~1~A1laJ- rpNM i~t Y!M rOM1q M~ fW 4!t L~ Mrr/w!~ Y~rf OM 1 M/NO ~+W ~l~ IM p(AM OCCY~[O ~1 M! NKf, OM wy ~ . rwrlKUU+: )a : 10 ~I,~ ~/y 'b'~~' x~•f ~wru wK up~ Kr~w. ~woN? e~e. ur, a w ra~ i ~6! Mq tM Nc •~u~i nor ~ - i1C - ~ ` ~ ~ tN ~ ? _ " ~k ~ ' - S / ' / C~ a rr a.o.~a~cl, w~ : ~ ~~J n /I,'• ~a//~i ; M .o _ CERTIFKJ?i10N-MEOKAI EIArY?aEt Of CO~ONEt- a+ ~w s~sn p a~t ¦ou~ or N.M rwe Ncia.n r~f .~oMOUMtl~ eW ~ ~~uwhO~w w M wsr ue/a Ml rwes~Wrqw, N r. o?w~0~~. ~O.nw M~N OCCOMN OM M MM M~O MI! ~O bl! C~YY~71 !tA*O M1 it11~ MDV~ ~ ~ ~ CElililEt-NAME ~nn w?n~n ,.7 S : 4 1A W/~ eeowe a rme ~ATE SIG?~D i..w~~, w~, ~w~ ?1~- /.J~'t ?a/ n/ t7~. ~ C~['s:~~y_L~ 1~'( C~ i!TC.! ~ ) aC . ~ i ~ i ' ) _ ~ t) i MA~~! A~E~-(Et~~t l~Mf~ Of f./ • MO LM • s ~M 1 2 North Fla ler Drive West ~a~m Beach, Fl~ric~a 331t~7 ~ { WMwI. taEMAl10N, ~EMO~nI fMEiEw O~ qE~MniOtY-w~u~E LOGiION an w a.+M s••n ~ sreta~ ~ ~M Removal_ r• Mount Rose CemPt~ ~w York Pennsylvania Oi?tE ~ raw¦. K.i~ ~?u+rEent HO+NE-N~iiwE nND ~DWESS ~ s~ e~ o, on o~ w,.w s~•n, u~ ' H. December 28 1976 ,,.11 cock Funeral Home, '~~~K'. ~ommercial, ~fensen Beach, Fla. 33tt5~ : Y. S. ~612 ~w+f.e~(p~/1 4R- ~EGKiely~;ss+Ga~?~J/ ~ / o•n• ceneo ~ocu ~cas~u~ R~Y•I9~0 ~ ,i• • / ~~1.(.;f. 1M. .~!_t.~ /i ~~l C.yy= ~ ~r-.'l.sr.~.,'.~. ,'S~ / ; . _ . . _ _ V' ' ' t , •'E~ ~7~'~ ~ . ! ~ i :~„F _ i; + ~ r ~ : s ~~l' ~ ~ ''i ; 9 . r ~ ~ I HEREB~` ~ER~IPY ' 1'fiE ~ABO.YE TO BE A TRUE AND CORRECT COPY OF THE REGISTRAR' S RECORD ~ ON FII.$' xAI ~ THIS `.QFFICE _ . ~ (Not:val~d uril.~ss Che ~eal of the Palm Beach County Health Department is affixed) F r ~ July'~2'''~ 191t'. . ~ _~.f~ v. .r" s _Y ' . , . . C.L. Brumback, lt.D. . ~ , ~ j Local Registrar ~ Bureau of Vital Statistics West Pa1m Beach, Florfda « ~ ~ 3 3 ~ 27 ~ oR ~ ~ 39? ~ 3 ~