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HomeMy WebLinkAbout0006 , • . _ , - - ~ ~ ~ ~ ' ~ / :Ai. tr~Te ~o~o o~ Nsw~~ CERTIFICATE OF DEATH ' . • suauu OR'VITAL fTAT1RIC~ ' ~rwTa rn~ rw. ~ FLOAIDA ~ ~ ; ord •Aew SIRTN NO. PCGISTRAR•D NO. p~e~ar1~ ~t~eptf~ ~lAt[ 0/ O~ATM COat MO` VW11~ R[1fKMCt(A~w.1.v,.•.•....a :~:~.wwaw• R~JNwN/~~~..ri~) •„d e111 ~'~Tr F3revard s C~ ST~t[ ~lOrZ~:~ ^:QVVtr t x . IIr vari~ e. ~l•c•~ - - - ln ~~r- 1. C~TY_ TMrn.O~ tOC~iqN ~~i ~ t. K~lAr: O~ OE~1M t. C~Ty.TO~N,OR IOt~Tqr t. 1S R[SM[~Cf •~p~•a Rock].ed~-e ~+R~o~r c~r~rs? COCOti ~~oE ~Tr u~us• ; rij•. ~ rc w? res Mo 1. ~u~E Of l1/ wN is ~Mral. Ma eeraf ~lbtM) I. STIIEET ~OORESS ? 01rluegthoff I~iem. liospital ~1~ Avacod:i r v~~nu~ ~ 3 ~u?r[ o~ ~ Firw NiMk Lar - t o+~rc aI..H D.s Yesr ~7y~eMpi,N) ~mna - lIarrison u,1~ OctobQr 19, ].955 s sex s eaae oa a?ti ~ wuaiKO v[~ wua:co • wrc os w~ s ~ec th ~e.?~ ~ ~woc~ ~.w~ u+a• r. ~ws ~'emale :~e • e u.u...' x.,r. o... s. t c• ~ ~noowcoC] av~cco Feb. 1, 1584 l ~ t a~• 1~ ~G. vwa~ aeur4T~aa ~a;r~ ti,~ N~r..~ s..~ We. Kym ae ws~essoN wovsr~r 11 w~N~IAtE (9~ee w pny~ ~warrp (e2 a+uo. os rwr m~w~w,r • uo4Y~'~"`f~'1T~`:"n~`.""i~•""`" None Tallahassea ~'la. USA ..w•.e s • ?laek fet 13. r~lwte5 ~u?~E 1~. rpTMtR'S MA~OEN w?rE ~ Ageun J~ckson Ceiia Sawver - ss r?AS O(CE15t0 EYEII M U. A A~YEO FOAttSI K socu~ s?~...~m ~o. s s~w~wn?wc - . FO t - tY«.~. w~.w~i UlM~.Mwr~MY~~/rw~i ~ ir • S' ~•^-~J 1S~ - •i1• ,~.a...51° Avaco•. ~,iQ. ~ oco , a ?un~rsl 1{ C11YSt QI OtATN ~bl~ft~ W/ Mt pwt ti~r Jr (~1. (61. ~~f (t?.j INTE11v~L ~ETN[EM ?4RT l OEa1N 1~AS CAVS[O ~ ~J ' 1 K~ OMSET ND DEA1M dtr~etor ~ ~(.l-l"•~i1,'Z.L~ ~ i;..fr.~ r L~-fJ1.~t./ •u~! lll• IMYf01A~E CMISE ~ J, r-- ~ . _ _ • tr• t~r- ~ ~ ~p~ t e "~i t i tf e a t• (y~Y(~y. ~/p1. 011E i0 l~1 _SGL=1~ ~ •lt\ tk• r~k~ ~tn rirt N - 1 • e a ! a~8~st tarsr - _ ~ . • r~sf~ar~r d~a~ t!r tw4r- OuE t0.(d ' - ~~~C' ~Q~~~ • ~E~L !?tiy 1taJt /llf. . MAS AUTOKt • 1 t N! 1~ '~s ~ ~AAT N. Oi~ SKyf~WT CAM011q~ OaAM~pAt p Dt~TM Mf NOt 11tU1R0 ~O IM[ 1[Nr~YI OR4fE CpiMt~00i Gw[K M?Yt 1(~l 1107/f• F ~[11iORY[~0.7~/ l~r d~~lA ~ 'L_ L~ ~ ~ rES? ~Dil7 o r te r• ~ 2a. 20s ocsuat ww wiwr oetwt~to. (E1ra w~ts.e N41~~ M P~at ! r Pa.~ ?I yYe~ r~.) •akfwj ww~ ~ ACL~DEKT SUtC~OE NOY1[~aE a~~~est- ? O ? se ~f ~ 20r ~uuu~OS lfwr Dq. Yar p A. ~ . ~ . . ~ m/- wuRr oeeulUUO me. KKC os M~xr~t f- i...n..[ bv. ml- em. TorrN. 011 loutaN ao~qlTr stl?Tc rrMw[ A• ~ MoT tMNr?t ~ . -la~.I~~Mr. ~?eN. ~fe M4.. de.l . ~ . NORK AT 110i1K - 2f. !~~undsd tM d~c~ /rom ~ •od fut a~w dih on ~ DwtA oeeu~r~d ~t ~ 2' on tA~ d~f~ ~r~t~d ~ls~~; ~nd to fM M~t o/ tn7 ~no~l~dN. /rom tA~ uu s~ ~t~t~d. ~tl ia•.• aMw~uwe (Uep rrYk) tb. ss . wYC o •r• te 1~ . ~y,~ ~ y' Z ~ 1 D ~ r ~1 •ttY~atf. 2~ h~~.t~r?t1pR b pAT( AME CEYELfR1/ORCRC+~ATOR1/ j3/. LQCATIpY~(7fy Me~. tN~fll (St~t[) r~efl4t~'t~Y~~h' ~ct. 25,65 Talla2iassce ~emetery TallahasseQ, F~orida Y.l.~Sli 21 ~~p~ ~'SS~GMATURE 400~E55 2S. WITE O.~Y ~E6. ~ELKTIIAIl5516MAiuRE A.,.,vse ~~.•C - - J.- r _ Cocoa, H'lorida ' /l:~t/ , ~ - ~l <<r c ~ I IiEREIiY CERTIFY THE ABaVE TO BE A TRUE AtiD CORRECT COPY OF TBE RECORD ON FILE IN THE L(1CAL REGISTRAR~S OFFICE IN THE BREI~ARD COUNTY HEALTfl DEPARTt~NT. (Not valid unless the seal of the Brevard County Health Departuent is affixed.) , . . . ,.`i ~ ~ . - r ca ~ ~ 1 x~~ ~.-~l -~CJ ~ . . . ;~,~y s~~~c~E~a~"i~~. ~ ss ROCEf1~OITQAb Local Registrsr - : ~ ` ~ . ? CLERR 61RCUlT C T ~ - rc~:~~a~f.R~ftEO W~~`.?` - " " ' : ~6 ~ . _ - _ . No~, ~ ~ ~ ~r . . .Q~' 2"~ ~t~ - Deputy Registrer ` ~S 3 Date .~`Seal ,~~`~r t~~ t~ It ~ , dUail Z / PACE ~