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HomeMy WebLinkAbout0172 ~r / +~~~f3a ~~~i~M~'Y F~~ ~ ~.;~~~r ?O~TR~6 I"'w+VOO ' ' r ~~~T ('„UF` 1 r ~ 1~~ - V ~ V ~ ~ ! ~ 9 IC~ a7 aN 7F Pala~n ~each Counr ~-ie~.ltli I)~ ~.rtment j s 3~ ~ p i CERTIFICATE OF DEATH ~~e/wulu.t~Q o~ ~~r..~lti •n~1 kr~~..l~~~ibllv~ ~t~l~~~ BTATE FIIE k0 iN~na~~~K w.~iu~ FLORIDA •'t C~c ?111N1 IN ~~~~•~^~•r•'~r.nm~• RE(:ISTRAR 5 NO ?ia~aNlNi INK DECE~SED-?+M~[ ..,oou iSEx SEf y?~0100~ IOi ~OwTE Oi D[Aln •+o..~~, e.. ~ ~ usnuuwn , FRAi~K (I~T~1N) .JANAT.1 I~ MAI.T ~IAY 19 , I ~7fi ~AC4 ,r.m. w~cw. .••n~car u.eur., ?GE u«oe~ o.w~~ ~ e•• ^ MlE O? ~1~iN ...o~... o... cour+rr w a~tN ; C ~ 1~tt~~~ r hll ITE s.~~~=j r Vuf~ urOt O~.• t~OVH ••w ; tu ~ ~7• / ~-?~-is~~~ ~ rn~.~~ Rf~ACII ~ D~)~ UT~, TOMR~. O~ IOCAIIpN Qf plAIN ~~ue~ t~n ~rus HQSMiAI O~ OTN(t l/Si11U/1pN-N4ME ..pt ~~rrt~. a~v~ S*~u~ ~~+o ~ srtt~.. •~t O~ NO ! ` t,~~t;r: t~,~k~ ~ ;~o i22s~ t1IL[I~tAid CIKCI.r:, c:t~t;n`,~ c~~.c;~i~ STAIE Of N~iH ~ n.~ot w u~•.-~+,~lTUT12EN Of WNA1 COUN1~1f w~RbEO r~fvt~ M41R1E0.~ (SUtVIVNC So'OUSE c~•t r~~ay~a ..~re- COU,+~~~~ ~ WIO~ O11?ftr~~ .,,,,,.,,b,.~~ , ILLI~OIS , u:s.n. „~f~R~`:f~ i„ ~~ii.DRF.tI fInLUB ~~,~.~e - - - - 1 - ,~~a S«IAl SECURIT~ NUM~(R USUAL (1CCU~AIIQN ~G~q ~w0 O~ +r0~~ DO,+~ ovouG rOS~ O~`~I(1?J~ Q1 WSiNE55 OR IttpUSil1 i ••~~~10 ~N ~/W~~r~G tvl h~M ~1•~~101 ~ ~~~w. „ 325-30-3520 SEL~-F.~iPLOYED - Rt:ALTOR fiEAL ~S"1:4"l'I? .~~~~~~~.~~e.~ - - - r..•t~•c~ iES~OE?+CE-su?E COUNrr CItY, TOWN. O~ lOCwt~ON ~~f~e~ c.n ~~..~n S~~(ET wN0 NUM~(f _ ~ ~ va~~• •~s o~ .o ~ FLOIZIDA ,.~Pr1LI~1 BTiACII LAKC PARK I~n 12259 I1iL11•tA~ CIttCLI: IAil1(!-NAM( .,yt r~ppq i•1~ MOiNf~-A4WINNLME n~v r~oae u~• „ I~RANK .TAti,'1TA ~tARY i'OI~IIRASF.t~ INiORMANi-NAw~f MANING wOpf[SS ~s+ae. o~ ~.o r.o. c~*. o• ~o~». s~.n, t~~ D1RS. ~1TLDRf:U JA~ATA 1~259 IIII.I.~1AN C[RCL[:, I.At;I: PARi:, I=LA. ,:~340:~ ?wtl 1 p(~M WAS CAUSEO ~Y. ~EN~Ef pnlY OM UUSE ?ER UNf iOR fo~ rbl. ~?NO 1~1~ urv+u~ owsn •rs a•~• r.re~~~t t~uu • ~ ~ (el ~7-~~~'.~l/u` ~~//C~ L 7_J/j~7~y~~%~ • ? ~o~ . `o..oM~~o -s. Ct ~i ^ ~ ~ J ~ ~ . ,o ~s? ~ -,~G i n, ~ , -aY- ~ h ~ . . ~rrlO~~tf C~Yf~ ~ol, ph ~O. O~ ~ CO~ OWKf W: ~ ~I~IIMO IM~ VMO~~• ~rIMO C~V/~ U~t ~t1 ?wtt 11. OiMf~ 51I'iMUKANi COriD~l10~+S: co..a,~a.ti can~~~~m•.o q w~n. w+ .a~ ~wne +o uus~ a.e.. ..~r ~ ~o~ wUlO?S~ u rES ~~n .~.+o.«c~ co+ 1~~f Q~'~~ O~ Ot~ w~ D~~f~rlr~wG 4V1~ • ~IA ` ~w ! ' ~ f?•sMey 1 ~CUDWi SUif~DE ~Qt~A E W ~ ~ rprrw, p~~, ~tu ~ MOU~ MOW IN/URr OCCU~~EO ~ wrH ...tun W~~iu~• u. ~ o~ r•~r u, n~r ~ ' ~o+~K~Ot~ OR INO~Ilaw~kEO , i " Isc+c~M = 70~ . ?p 7G M 701 ¢ INJURY Ai WORq ?IACE O~ WrillY .o+~. rur, smu, ~K~qr, IOCATfON ~ sn~p p~ o. «o . C~n O~ ro~r, iun ~ ~ ~~r1Un qf O~ ~O~ WiK~ NDG., 1~C. ~ l~K~A ~ ! 70~ ~M ~ f ~ i CE~tuK~T1pN- ..a.~~ O~~ 71~~ rO~M D~~ ~f~~ utt L~+ ~Wlwl~ ~uv1 OM ~ M/WD r.o+ v~l~+ M[ Ol~iN OCCU~~10 •r rwf ~~~cf. o~. ~ rNr3~tuN• t0 - ra.~~ o.. .u~ ~oo. .rrn o~o~ ~..w~~• o..~,•...o. •e ~w u~ ~ .m..ow r.~ / 1 ' / c~ .-.o.~uoee. e~~ r ~ tl• oa~.s~e no+ ~ 1 G L 7~~ !%FQ-( Ih 'Z~- ~~V )t~ tt~ 2: 171 M r0 rwf (a~L~f~ sr.nc I_ - ~ 1_- g CNn~K~r~O?+-MEDK~I EYwrw~r+EO Oa COeO++E• a. ~.sn or rrw .ou~ o~ w•n. oeuoe..r ~.a .~o.+w»ceo oe•o . n•.w•r~On d K+o• ..ro/o~ •.ne~~w~r~oti. ~w MW~OM. /~~Ii~l oa• .ur .nu¦ eu~+ occwno o.. Me o.n .we ow ro~.~ c•u~~~u v.no 1h M. ~ ~M 6 CEt11l1E!-N.wE ~nr~ o~ rn..n SIGNATURE , own~ o~ ~~ne ~O~iE S~G++fU ~~«r.., o•.. ~eu~ 4 ~ , , ; -s ~y _ t~,yr)~ $pivey ~ 1/~ _ H.ll._-"'- - ' rw~NU~(1 ADO~ESS-CEem~E~ s+.~n o~ ~ r o -a ~ - c~i ~ fy-~{ ~ r ~ ,u 2R01 N0. rLAGL . 2 QRi 'E, ~~FS'~ P~IL~t i~ .:1CFi. FLbl:IDr1, 33~1tS7 ; lUt~~~, ~IEMAt~O?+, REMOv~t CEw~EtEll~ OR CRfwtA70RY-NaME IOCAiION c~•. o~ *o... s~.re ~ trlci~r ~ ~ CREt•tATION i~. CALLAWAY CRF1~tATORY 1., Ll1 I: t:'nitTH, 1=LORIDr1_ OAiE ~+o~~~, o.i, ~l~U fUNffAI NQM[. ~aM( ANO ~DOo(SS suen o. . r o ~n . u,• p~ ro+~. ~•.q. nr , s-2i-i~~b ~~.~oR- ~oo~ ru~r:« iic~~~~: s~,ox r~ , ~ . : - E-~.,~. 3~.ior e: /61) ~ fC1 RIG~SI •_S~G~:a1VI( ~ !(!~v ~r d~~ ~ S~N ~ _ ,t ` ^ ~ I _ ~ ' ` R~v.1910~ • c ! . ~ ° - - ~ . ~ ~ ~ ~ - I fIEREBY CER7I FY TIiE A60VE TO BE A TRUE AND CORRECT - ~ COPY OF THE REGISTRAR'S RECORD ON FILE IP! TNIS OFFICE (~~ot valid unless the seal of the Palm Beach County - - Health Department is affixed) s C.L. Brumback, M.D. Local Registrar ; • Bureau of Vital Statistics • November 9, 1977 - SEAL West Palm Beach, Florida -r,. - : ' ~ • R ~SO P~GE i`12 = 3~OK p . . . . . . . . . . . . . _3`' _ , . _