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HomeMy WebLinkAbout0793 - . ' • ~ / 38,~~,~ State of FIoHd~ CERTIFICATE OF DEATH Deputmenl of Hedth ~nd itehabilitative 8enrices rrwT~ nu No.------ VITAL BTATI8TIC8 F L O A t D!l _ ~~o,~~~~ s?+0 293 ~ a TVVE OR PRINT 0!ClwSEO-?~~N! ¦ Ow [ OE~tN ~•o~•.. , ~N , WyA'i'1+ I~ID HAi~dCI[$ : Male r 14, 1977 PE RMANENT BLACK INK UK! ..m• wow. •.~~K•.. •GE-~.u vw~ ~ a•~ w~w~ C~tt 01 M1M ~+O~ww. Nr, (OUNi~ O~ OlAIN ~a . wcr. ~ a~w»•. ~ sa~~~ ws ~..t ~f w~ nu f 6602 ' w 67 ~ w ~P'!ar• Z. 1910 Saint Lucie ~7~Ow?+, O-i [~?fiaN aT ..ws~ cw. ~wn NOSht/?t p Oh~ta ~r •~o~ ~n.y~. o.w ur~. w ww~~ ~ wcw• ns o~ Ms ~ Fbrt Pieroe Yes N DOA - Fb~rt Pieroe Menarfml Ho~pital ~ S AtE O~ ~MM ~ M yO~ ~M Y~~. M~N [ d M1q~1 COUNI~~ MAflEO. NErEf MAl~KO. NO ~OU^SE i+ ~ ow~ ~awr .r+i ~ cow~. ~ 01VOKE0 ~ vo ~ _~~u N....K. , ~ Flarida ~ USA ~iwmec~` t~lone - - - - - - - - - - - " - ,,.~s .«.M socu`u secu~m Mwiii uxw acu?•~~oi+ ~.~.e ¦w o. .o.. ww w~e .w. a vo a ws.+ess a wovsnr OCCMR~ M ~OrMO ~M. Mr u ~lMM ~ - ~~nK~mo~.. e~e DEQSr171~lit Of AC~1Cl11tL11''e .~r...~~ «.o. 082-24-7439-A ~s Ins ect+o~ ~s - esoeace-sr~a cow+r. + cmr. Town. a ~ocwr~o?. s ~ - - - F r3da 3t. Lt1Cl@ ~a F~O~ P1E~.1~0[~ ~~wcN. .~w ~•o ~N Rt ~1. BUX 41~ /Aflrt -NIM[ ~Np r~~ ' l~q M011~t-IM~D(N N~M[ ~ys~ ~NM~ uv ' s; tt 0• HaWklT18 ~ He11P. M1118 - w?~~+0 ~OO~E33 ~sn~n w ~ wo . cwr w w.... u.w. ~r ~ ,ti ~th W. ~729 S. llth St., Ft. Pieroe, FI 33450 ' 1. p~/~M 11rA3 CAYitp ~tr~ ~IH OMr pE UutE rH l~+[ /O~ ML IK ~O k11 NANM OMN~ ~y M~ cARD~ q c /~RRfS T' ~ ' COMM~OM~ M ~M~ ~r~c~ ~~d ns11 y~i~ ~ PI - ~f~flM~ N ~M~K ? • CO+YMK-Td~ _ /9 R TE/~i / os E~to T~ c fj/EH~e T' D S~~ S.E i M?~t M 0111E~ flpNlrKAMf CONOIfIp~S ca.wwan caw~rw~w ro Mw ~n .q~ uuw~ q cws~ ower ~ r.n M/tOKt Y ~ES .u~ r~rHros cor- p N~tw /S! Y Pfi~ TENS / 0~? (~ASfir Pi,cv fo~r h~~H ek~o ~r . , ~ M ~ ~ u~ ~ wO~m. M~, n~~~ ~ NOM,~N1W~ OCCY~~ED ~~Mw~ ra w wwtr ~r rur . w r.n ~n. ~ . + T!f/~l9 ~ ~w .~~I - 7 7 M~~s,~f PI ED //V T/f~ ~i~ESE~1'~'~' tiF ~ t IMl11~T ~t wpq u.or. fw~?. r.c+o~•. IOCAf10N ~~wen o~ ~~~.w . an o~ ro.... u•w ~ ~ ~ wa.. n ~ e~ .a ~ ow~ wo . ~t r. ~ - . o ~ T o i r' N~ ~c~ CEttAKwiION- nw~w nu .a.we .~u u~~ ~.~....i.p •~n~ w~ w~M w: nn w~ el~rw OccwNO w h.u. a. ~ IMt1KUN: ~O ~0~1w M~ NY ~MH M~~ . ~rp~~i ~ Z ~~M. ~M. q M Mi~ 1~R~MN~ AM p rt bOVlfKd. NM }M Nc~~N~ ~lO~ IN t6 iN fM M ro wM cNrM~U sun~ ~ CERT~?KJ?~ION--r~EOiCnI w M uws a.w woM a r.s rw Nc~w.n ~~f ho~ou.~u~ N~~ ) ~tuMawOw d M~~ ~M/W Iq ~Mtti6?~. rw r~ O?r~0~. ~ Z ~Wn~ " Nt 1~~ MOV~ < O • ~ N~~w OCC w M ~ ~A~ s Cl~r~iNrn ~~~~~L_~J~A~/ S1GNA _ M/A ~ Lp n -~_~bA~_~iEG ~+w~ N~. t~r~ . ~ c t0 LNiGu~~- _~~j~ ~ _ ~ ~ ' ~ , wUING f-(fltl[~ t~u~~ w~ r• ~~cm w.« w~n n. ; fY ~ f' L I L - - UEMA . MMO~AI h OR C~EMAtp1_NUt 1OU110N c~~. d ro.~. s~•q - ~VKA~ C,rereti,on Ft. Pieroe Cce~~at,orium w Fo~t Pierce, Florida 6~ ~OM~~. M~, ~IY~ fUNffY HO~-N4~M[ t MO~fSS r fuqt O w0 ~n ~p~w fuq. q~l 33450 ~ w ~e, i9~~ Yat~ rvr~~ tiy~, r~. ~ VS. #81T ~UUt1M aG~S~w-SrGw~tu~ c n~o iocu e[o~s~e•~ A... ~ns J ' r8 5-18-77 ; - ~ ~ ~ I Mroby osrtify fhls fo bs s trus snd oorrect copy ot fhs Loui ~ Rpl~t?K's record on file in the St. lucie County Health Dep~rt- ~ m~M at fort Pierce, Florida. ~ mM ' p~Ep OIiR~; ~ (Wuning: Nof valid unless raiscd seal of the Sf. luci~ E?K CtaGU~T COUR~ ~ COVnfr HNith Ospartment is affixed.) r yca f:~n , ~ A ~ iV. O. MIIIER. M. D. QC[ ~6 IO 15 ~ Count~? Health Offiter 6 Locel Rplstr~r , s- ~ - 3826'70 0~1r O~Wf~ loul , . ~ • T _ Dl~ o~~~ ~~,~r _ ~9~- ' ~K