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HomeMy WebLinkAbout0457 • - 3~~s2 . ~ / . ' Reae. ot i~id. . CERTIFICATE OF DEATH ~ ? ~ D~p~rt~at ot Ilealth and il~hablMtath~ 8ettioe~ tr~Tt n~t No. • 1 ~ ~ FL011IDA , VITALBTA'Ptel'1(~ ~coist~~~•s No 579 ~ ~ TvPE OR M11NT ' ~ • • ..o.~ . . 4 ~N , r~cti• F. ~a , ~e , o~o~r zo, ~n ~ ' ' PERMANENI ' ~ BLACK INK ~AC! wNe. wticu~ wrr. AO!-ua rw~ . n.~ w~~ ~ w,r c~nj a ~.~o.wr. w.. ~OIM1~~ d OtAtM 6602 ~ ~Wt~~ ~j~ M~~~us~*r0?. Mq wO~A~ w ~t1~~13~i7Z1 N st• iJlA~:iC ~ re ~a ~i~~ ~.~M cw i~rw ~l - ~r ra r t . Nn tiwn u~ wwM~~ ~ ~ fNtw H~ O~ MO w Fblt P1CrOe ti Yes N Fbrt P1el+oe MenDr ~i.tel ~ : ~ A ~ w w~ w. v.~ rw MfMt COI~II~r IYW~I[0. ~Vl~ ~MYlO. ~r ~•w wMw w~r ~ ~ ~ i tewr~~ wnOwEO.OaOK[O~~Mte~ ~ ~ ~..N ~ t~rth Qa~rolin~ • t~SA - . Married o_G. ~•_Ht~~ ' # ~rtN Mch/N SOCW S~C ~?11MM~f YiUAI OCMAt~ON ~~wf aw M row ~Or1 Nr~» ~OM a [!b OI MISIIE~S d M~YSI!'I '~i ~ u.~~ r N~F ~ OCCM4~ w ~'O~N6 ~M. Mr r MMN ~ ~ „ 240-14-666~ ~s Hous~e wife ~s Own ~ :~n.~...o i •~rsron. ~ESIbtMCE-S • ~OIMA~ CM. IOww. O~ tOC~1qN ~rM c~r ~w~ ~ ~ ~wcn e~ rs FLorida St. Luci~e Pbrt Pie.roe N. 3 AMt -M~rt ~wa ~.~y ua MOt~l~-w~D~NNU~( r+w .wn ua~ ; n F ~ l~c ~ sori u ~ Wlr~ A~~1S IY~N~ O~ ~.1.~. MO. O~ q~r. M~A. t~~ ~ ~ G. P. Eiurd u. ~'l123 Olearxier A. : 0lA1N wr~t Cwufto ~t~ ~Nn[f d+1t OnE t~lAt ~ t~! Id ML Al ~u+0 k~ ~ ~,.w~ .w~ «uw ! . ,.i a~ P.~?~..~.w~ ~ w ~fivt c,~~• • ~ ~ i i ~..~ow • ~ . . ~~nCw N~ NN ~ M • ~irfM~M ~~~N ~ , ~ lUhp ~N • • ' ~MM t~M! Y { a ; • ?A~1 ~ Qil~~ ~~A~M C~1~1~: tOM~1~OM tOMMM~~ ~O Mur ~M wp MuM~ p tMfl ~~fr w rW ~ rts ~N ItrNr~f COr? ~ . . ~h~r0~ MM~TM NM/~M~ lYM ( ) ~ } i ~ ~ ~~Or~w. M~. ~ 11QM IN11N~ OCCYNEO ~~M~~ W~M O~ MIN~ W~~N 1 O~ ~Y~ 1 > _ t ~ 1M M. fY ' i ~ u.o.+. f~. ~~c+a.. lOCA110M ~ aw~ o~ rs , cn. w a.r. r.M ~ ~ ' IMKM~ M{ M~ M41 ~Y~.~R ~MKM~~ - r ~ ~ ~ ~1~- OpMr Nt t1Y ~r M~ 7~V w MH M~ Ar/wN N~M O~ ~ M/M ~p ~~r ~y ~lA~M OCCYMl~ ~t H~u[~. O+ ~ i ~W~ M~ »Y Wq ~NM M~w ~~OII~~ MM. ~O r MP t ' ~ ~ 9 / 30 / 7~ 10/ 20/ 77 10 ! 19/ 77 Did not 7 :15A~? e: ; . ~ ~ 1M ..tl.N. q0. ' N~! ~ f~ ~ Or ~ Ms~f p~ ~oM M M•r f ~¦..r..~a. a wr ww wiW w~ wwp~o.wer. r~r o...a~. raww wu ww~ , i, ~ M~~ OCCIIrM b~ M NM u~ MI ~O 4f C~oM~N p~A~. ! . M 1D M ~ : ~ ~wn o~.~..n , «a«~ a ~+u I+OK+r. M~. ~fYl ~ ~ Fboshan Kad1v M ~ ri 10 20 77 ~ ~~t St et S i te 3~F r~ ~ p~M M ~ f ~ acw? . tw~rA1 ton-wiwE c„. w w.» s..n $ ~ ~ YKA ~ ~~~L CL'~PSt~iQr~al F1r,rF v;n,rY•o ~~r„-~,a~ ~.o+~. M•, .t~~ RAl NOME-M/u~[ ~ND ~00~[SS ~ unn o~ ~ r•..o . ca. o~ ro..., ~uM.~~i~°-~~° °iO`--i ~ ; w Oct. 22L 19~7 n. Yates Ftia~eral ' ' ~ i v.~. *8t2 • i ' - - - a tus ~ . . • .•+e• n ~ow Ma i E R«. ~ns ~ ~ ,w October Z 1 ~9~17 ; ~ ~ i ~:~J~' ~ ~ fIlEO AMD IiECOR0E0 _ .3~ `R ~ =T. WCIE C4UNTY Fl~l. ,ex; _~f • , : s f; 1 hsroby oKtify this to bs • tru~ ~~d correct ~ ROCf P. POITRAS ' s~' ~ . i ~Y ~ ~ C~ERR GIRCUIT COURT " ` Rspbtra~s recard on fik in ths 5~. lucl~ Coumy Heafth DapaA• ' • m~nf d Fort Pieres, Florida. . :F~Ep • -'.r - i , ~ ' I_ p ~ M (YY~rnirp: Not vaHd unlsu raised ~eal of ths St. Lucf~ ~~T 1~ 2 53 1~~ ~?~r ~ z~ y j . ; Camt~? IINkh Dspartmenf it aHix~d.) ~t , , • . ~ . . .J•~•i~' = f ~ ~ _ ~ , • i!M~ ~ . ~ ~ ~ N. D. MILLER, M. D. ` . t`-~ ~ t ; . Countp Hse Offic~r 6 toul RsybhN ~ ''t i + . ~ : ~ ~ ! ~ ~ l0 y/ ' ~ ,n - ` f CvJ/~1 •~X~ . `,tr~y~:;. . . ~ : ! . 0i~'» ~PU~Y loui'Reo~a.,K . _ ;Y- •jY~'r.;.:¢'~°' ~ ` ~ . ~ ~ ~ ~ ~ ' ~ ; f ~ ~ : . ~ ~0~~276 PA~~ ~56 . ~ ~ , , _ _