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HomeMy WebLinkAbout0867 I • / .~yo4~o ~ I stateotllotia. CERTIFICATE OF DEATN ~ Dep~rtment of Nealth ~nd ltehabiHtatl~e SeMces F L O!1 I D A *T~~~ si~t ao._--_ - Y1TAL BTATtB'1'iCa ~coiaT~~~ s No 546 ~ ' A _ .~a~ A A ~ .orr.. .e• ~ ' I 7VPEON P~INt 1 PI~. t~l@ 1 ~ eni~er 24, 1977 ~ PERMANENT 9UCK INK IuCt ~wq. MOW. ~~~~K~r ~Wur. wOE-l~tt wa~ ~ n.~ wa C~tt d M~.w~+. ti.. COUM1~ d 0lAtN i ~K ~Mft~~ V~wN ~t~tlf~ r01 Mr! MOMf ~M ~ q~~~ 6602 • a~ . ~Dec. 14, 1920 Saint Lucie ~ C~{ ~~M l wYe! cw~ ~~~f MOSMAI OR O - ~w r0~ ~w 1 Ow1 t~M~~ ~Nr~t~ ~ ~ " V~t Nt ~~f W MO ~ Fbrt Pieroe Yes N 114 South 20th Street M6 S~OVS! 111 d ~ r r0~ w ru~ CI M w?Ql COUMl~? MAtMt~. NE~E~ AW~IlO. ~M w~ow w~ ~ i toww~ ~ wDOMRb. OnOKtO ~ wc~n ~ ~ I «..~.K.. ~ Wiest Virgfnfa + USA ~~i~ _ i~ee K~-P~ ~ wr~q M[I~ff~ ~~.u • N~M S~CU1 ~'I~i' MU~i~ USIIAt OCC1M~tqri ~a.~ ~w w.w~ w.~ w~wo ••oa w tND d NlSNlSS O~ WVS r f OCCYM~~ M ~OM~~6 ~~N. MM P„M~~ 1 ' :,,'m°~i N,`u,~'. ~e - -r r ~i i1.S~Wlfg ~s ; srffor QSIDEMC!- fAt COIMfr Cp?, IOWN. d IOCAf10N M/N (A ~~~M ~y i ~ ~ V~tw• O! Me ( ~w w ~a iu ~ 4 2 ~ M111l~- ~.qt .ya~ i•ft MOTMEf-~ADfN N trtt rw~~ uf~ i „ 1 is ; ~ _ l~ulNG ~ODIliS rfwtt~ w~?• w. cw~ a w... n.w. tr~ ~ 4 450 _ ~ N~ OtwM w~f GuSE~ h~ ~+r(t aw? prre uuft rE~ ~aE ro~ ML A1 kM Nti~M O+M1 ~r~ N~ti ' ~ 1 yT. ; ; . ~ ~ ~e..mo.. ~ S ~nCw ~~~I ~~H 1d ~ h) _ - f ~~YM~q ~~~f~ 1~ K O~. . U~nw~ tM ~N ~ l~~ t~~M /Nf ; ~Aft ¦ O~~ ~MM~AMI CA~~~ COM~~Wt (O~MMMO 10 Mal~ M MM MuM~ M(~~N e~lr w rJt . w ~ ~~!S .~n ar~~.es cer~ . ~~H W re~ d Niiw NpNnnre t~~M ~ ~ 1 q A M t ~~O~+r•, Me, H~~~ IIOM IM1Wt OCCUMlO ~~rM~ ~uh1M W~~wf~ w r~p ~ M nM N, Mr ~ i ~ ' M s~ r w ° ~ n .or. . +•wN. ~.nan. tOC~ho?+ ~ ~~n o~ ~ ~ • .o . c~•• a ro.•. a.w ~ ~ IMN~M ~If r0~ M~t~ /1N.,~R ~MhM~~ ~ , . ~ ~ ~ ttHGt10M- .s.~. a~ aM .o.~r w• ~u~ ••w w. a....i.q aw ~~riM w~ w~m ocpMt~ w~.a, w w~ S ~~K16M: 1O N• r~Y ~OM ~~/M M~w~ ~rer~ NM. ~M. b M Mfr ~ ..m».. ~ ~~24~77 9/24/'l? 9 24 ?7 a.....o.,~.o.. . ~ }1~ Ntl•M~ HO. f11 !M M t0 ~N C~vMM~ Y~MS ~ ~ cE~Ki?f ' -~~l a. ~ a «r .or+ w ~w... N N~~ f~u~w~tO~ Or wA IM~ ~M/ wy w~f1~4~~qw w w a~~rqr. r N~ roW ~ ~ ~aw eccvw~ o+ a~ NN W~M b ti c~tilKi vaw~ ~ ~ M ID M ~ . _ ~ McN~ W nAI ~rb~s N~, H~~~ ~ Ct -NAM ~MI W r~+h ~ ? r rt • F_ Y~ ~ a=k~ns, r1.ll. ~ ~ .uK.+o ~oo~c~ Cf~fltt - j:w ~ d •.w - c o_i a.~ s.•w ~r i ' I7/ C~EWI . l C~EMA ORr-N OU c~~ w w.~ s•.n _ ~ ~ YKMi ~ r w ~ k`_t,~'~.erc~~toriun_ ~brt Pierv_e.-- Flgrida__ ~~i~~- ..wr. ur, ~e~~~ f tAl HOME - N.uw[ ? ~Dp?tSS f~nn o•~.• ro cn. or o.., +••n. u• ~ 0. 1971 n.~a~ ~'~'17, E't~. P~eroe, Fl 33450 w • V.S. ~12 ~1~ - . NWSf AtUlf - ~ ~ • t rr O ? K~1 ~ N~~ p«. ~ns " eptem~er 1977 ~ ' ~ ~ ~ -z t `K f 1 hsrsbr aMify thts to bs • true snd oorrect copy of M+s l~oui ~ _ Rsplthar's record on ffle in the St. Lucl~ Coumy Health Dep~A• FIlEO ANO RECORDE~ i : Ir~nt ~t Fort Pieres, Fiwlds. ET.lUC1E COUNtY flA. ~ ftOCER POITRA~ - (Waning: Not valid unles~ reised seel of the St. lucl~ CIERK C~RCUIT COURT Gountp Hsahh Depertment it effixed.) "'r"" '~ra~f~ED , ' ~ _ N. D. MIIIE , M. D. - JAN I Z i i~4 AM ~~Q ' ~ Countr Hea Offtcer d~ locil Repishsr ~ ~ ~J ~ j / ~ 7 ' li' /h ~ie- a7JV4 `Q ~ ~ O~ Drpuf~ loul Reai~e.~. ~ . . r,`,;? ~ ?_3 ~ a ~ ~'Y; ?OOd~w YAGf OV~ . 1 az ' - - - - . - - - - c,z; .'fi' . _ . _ . . . . ,._ea