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HomeMy WebLinkAbout0257 . 38631 2 ~ . ~ , Sl~te ot 1?br{d~ CERTIFICATE OF OEATH ' Oep~rtenent ot Health and R~h~blNtaU~e BeeNces f L O 11 [ D A ~~T~ n~s No. y_._ ' VlTALBI'ATiei'IC8 w~o~st~~ws wo 6S2 ! A -N ~ t i O~ A ~ rOMM, ~N~ ~ ' TvPE OR ~RINT ~ ' ~ i~At~a IFE WA~T~OI~D ~ i?~le , Notiarber 25~ 1977 ' ?E RMANENT Frs t#x lact .w~w_ wsa. ~unt~r M.~. . ~O! -~.a wu wa~ ~ a. C~~E d MM •.a.~+. w~, COUN~~ Ot Ot~tN ea .rs~., ..cz:.-:Kas:• _-•.'T _ .,eY~f _ o~„ n.~. ~si ~.~~e Q4~t+.~ T~r.~P (,602 ~ ta „ 52 , " , _ • . _ ` . ~iA: T$i~ii ai Id~FitfiT~li~~ .n~ ao. ~~.w~ Mosm~t d o IM MO~•~N I~M~. ONI 1wN ~y W~N~ ~ +ncr. n~ a Nn ~ Pbrt pierce Yes M Fbrt Pie~ Me~urial ~bspital A ~ r rOt r~ f~. w~rl ~I ~YMM ~01Rlih J MAtMfO. fllrf~ MA~MEO. S~OVSt ~r ~w. sM ~~er ~r.W ! ^ • cawN.~ ~~Mc1IY1~1o'wcr.~ - - - ' ~ Flc~rida . tl~A Lorene ~ ' ` . - - - - - - ~ ~~n~ • M•w SOCW ~ ~ii NIM~1 V~WI OCC1N~tqN ~aw iw o~ +oi. ww ~w.~+e .or a' tMD p iUSM4SS O~ ~+MKttr - - - - - - _ ! accrw~ ~ +erw ~w. M.. . ~ ,"'.'K ~r 264-24-4570 ~s Owner - atAr Service Statiost ' ~ - ~n+. i ~n ii~[tt T?.7b . .Bi - - - - - - - - ~ ~ ~LDE~-ft~ ~ COIJir~t~ _ CO~, tpw~. O~ lOCwbOr+ ~w~»• n~ w ..o ~ - ~ Flori,cta st. Lucie i~brt pieroe ~u ca~ s117 pir~etree u,rive ~ ~ ~ -N ~rb~ • rMi1 i•f~ r01~R~-M4RMN NU~ ~rs~ rw.! ~?v ~ ' i'lldlter WatfOid N " JOhruiie Dvwl ~ . ~ - rutlX3 AODQSS ~~nea w~ r• ro . cw. a•o..., t•.w. tr~ t I~o~+ene R. Natfvrd 5117 Pinetr~ee Drive F`t. Pieroe Florida 33450 ~ dtAM r?U CAVltO ~1• ~(N?!~ OM? Odf Ut/ft ~tI INt ~d NL AL ~MD • ~ r l ' nr~w oMn~ N•w ~ i , - ~ ~ • . ` :°.K:"::L « ~"'r wi -(~~I /rVMaM u~~ y~, ~ _ ~ ~t~1~M~ •INK ~ It~N ~~iM t~N ; ??M r 011~ ~YIf C~• C Cdw ~D N~w~ M MM MYM M(MN ~Mfr r rY~ ~ M~ ~sT r'/~f N~~ nrhw~t tb~~ } ~O ~q~ pN~N w MwMn.wr~ twM N Na~r y f* ~ ~ ~ .a.s. Me, MOw IN1Wt OCCtNfl~ ~~~•n~ n.M~ er .aww w~aa ~ e~ aw M. ~r. f ~ ~ 1w M 1M •~Oy. . f .~~RMM~. lOC~110N ~ H~~ M~ t• MO . iM M 10a, MM ~ . fW[M M~ r0~ A~~.~R IMICI/~~ - _ ~ ~ ~ ~R1r~CAt~1- tlw~ Mr q~~ ~d+~ 1~~ tN~ 4Lt ~r/rN ~lM Or ~ M/ ~M MAM O(CYNl~ •r ~y hK1. d+ ~M ~lKYM: ~O ~M~ M~ MY ~ON a ~~OMr ~~w, u~. b V Nt~ ~ ?~NMN~ rM ~ 1N MfUN~ NO~ 11~ /h 711 TM ~ M O ~N ir_M~ CI~-K.~~IO~f~ OM ~M MfN d~ w01r~ b M~w~ M ~NM ~~1 M0+01M0~ N~~ - ' e~~r~wwp~ 0~ ~M W~? ~M/M ~V ~MftiO~~br. r w a~~ntr.. ae.nr Nr .~p» ~ Nf~~.w~ OC(~NO Or ~N Mq rN ~YI ~O ~I b~11~ti f~M~ ll~7vR~-~ H~M M Nwb . . . ' - - M Y'- O^ nn1 3 O ~ Mi :t~i Mel in o~k~+~kY,M.D.P.A~. ~ .D.P.A~'• f-y__r-~ y ri1N° 802 Nort 'ltti~ Stroe~ Fort P~.er lorida `~~3 0 - Al. C1IMA . MOY C~EMA Y-NA lOCA110N c~.. ew wrw . va ,~~Cretation Ft. Pieroe_ Ct~tAriun - - Fbrt Pieroer Florida_ ' N~n~ati~er~ ~;N~97 ~ Ya~ee ~~mera~. " ~ • ,•~~x '~'Jy,~F~. Pieiroe, ~F~lor3.~a 33450 ~s. ~a~: fv+t - a- ~tc,~s~~ - sirr.,~e.~,~t . ~ ~ . ~ . a s i a.. ~/~e ~.e J7 s't,~ w G ~ t~ ~-'y'~ ~ h~robr ce?tify rhf~ to be • trus snd correct copr ot the Locai Reglslrer's recv?d on file In ihe Sf, lucle Counfy Neafth pep~r~. - . mtnt st Fort Pierce. Florida. i j ! (VNarning: Not vatid uniess ~aised seat of the S~. Luti~ ' Counly Heshh Oepar~m~nt is sffix~d.) h`" r` - ; } _ . ' . ~ f LEO AMO RECOROED ; N. D. MIIIER. M. O. :~.LIICtE COLMTY flA. . ' County H~Ith OFfiur d Lotal Repi~tra~ ~OCER POITRAS ~ ~LEPK CiiICUIT COURt r' sl ~ /~_a2~'.~, . ~ /7 rrrirriED _ . - ~ ~ _ . , a~ aP~My LOw) Q~ois?rM ~C ~ ~ ~1 ~ ( (7 . , ~ , . . , ~ 3~6312 ~ ' " ` _ ~Gu~ ~~8 PACE z56