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HomeMy WebLinkAbout0605 S- ~r ~ ~ i . f~~~~ ~~3 / G~ • ~K +~CU~t OcuRT ~ ~ . . . Y[P'i1~0 ~ JaN 31 12 ns PM'~p CERTlFICATE OF DEATH II~~fIMlNI ~ IIN~I~ ~w~ Rr1ul.i1~l~llr~ trt~ke~ fTATt Rll[ NO. ~M~~~.~»~~~..~~~~ FLORIDA MY~~M~RY/~~~'1 p<GIiT11AR~• NO ~f ?flNl IN ?ltMANINt INK ~N~ ~SEt CA/f ~ DFA1M ~ ~ow~w, O~r. ~tu ~ 4fE qu0160[ (Gt OlCt~SEO-~+~ME ~~ST~~~~a.s , Mar M. Evans ~ Female f DecemSer 11 1977 tACE .~~q. Mlaw. ~r~uc~~ ~w~~..., AGE--~.f~ v_~on uw~~ ~ s~. CAIE Of ~ItTN ~~0~+~~. 0~~. CpuN\Y Qf OEATN , ~ 2, :o, ~ a.-. .o„„ ; 1.~.., ~ ~ ~ White~~,. 67 ~ 1~ May 12, 1910 l,. Collier Cltr. tOwn. OR tOCwt Ofw1N wWe Car ir~~1 ~NOS~TAI OR O~NER NS11~1l~~~w .Q~ ~r ~~rw~. ar~ ~n:~r .~.e ..u..u~ ~ v~ar. .~s o~ .w , Naples Yes Naples Comnunit~r Hospital STA~E Oi ~itM ~ u uo~ u+ v f~,~~r! CmiE?+ O~ w?ut COIr+tRr Ml1l~IlD, NEVfI IMRRiEO. tSUIV'NN(' S/'OIJSE ~~~u~. on~ +?iM~ N~r~ ~ ~pr..m ~ ~ W WfO. 0 CEO e wtrr i - ~.Massachusetts . U.S.A. ;,•~arrie~" George F. Evans c~u.us ~1~ ~GVf1ir MUM~Et NSUAI OCCV?ATION ~aw awe o~ ~.on oo..~ ow~..c .~oa o~ tkq Of ~US~!ifSS W IaOtlS?t~ .~.:L .r o1.s .~~f0 ~M W~~~MG 11~~• f~fM N ~fM1f10 ~ ~~••w. ~,.Reti red Di rector of Curricul u,. I swich Mass . School S stem ,,,:,.,~,~„6N „ 015-16-6056 y 4~ RES~OENCE-S/A1E COU~'1Tr Cnr. ~Owr+. O~ tocwapr~ wYN tw~ ~rNf STlEE1 AN NU~M~[~ ~ ~~f~K~~t ~~L M r0~ ,N Florida ,p St. Lucy Jensen 8each Yes 9700 AlA fATH(R-NAME ~~qt r~opt uft ~MOiMER-MA1D~N NAMf ~~~1+ u0pi1 ~w1T „ Patrick h!acken ~ Anna ~ Tormey 1l~fORMANt_NAME ~l?sa+G w00RESS ~~~~~n o~ ~ ~ e.a . un w~o.rw, s~.n. tu~ . „~Mr, George F. Evans 9700 AIA; Jensen Beach, Florida 33457 ?wRl 1 p~/~M WAS UUSEO ~fN?ER ONL? ONf C~VSE ?[R IINE ~Of to), ts). (~)I '~~r..uM o~?n •sc o~.~r ' q ' wrt ~f ~Yt~ . ~ . ~ . 7 a, ~ c~ L . i coM•~~wrs ,...n ~ WMICM O~r~ ~1{~ tO ~rr10~~t~ C~YfI 10f, ~ b. « Af ~ COwllpVl~+(! O~. t~~nr6 ~w~ vw0l~- 1 ~~tNO C~YtI l~ft - ! _ ~ . ?ART M O~?~ER SK',M~fICAMT COHD~T~O?~S: ca.ano..f co.wn~w.w w a.n. tu~ .w~ Kuns ro c•vu o~nw w. ru~ . a~ AUt0~1~ N YfS r~~~ nwe~w6f COw~ ~ h~ « ~q~ ~ f~saw an~+~r~..a u~u , w o~~~w ' ~w ~w ~~.~eW~ AC N A ~.p~~w, ow•, et•~. ~MOW INIUl1 OCCU~RfO ~tMr[~ «atua o~ n..un ~r ?.a ~ O~ ru~ u, ner ~ ' . ?~q~pM~K~6f~ OR tM+DftERM~NEO 7Do ~ ~c M ~7M ` ~N1URr ~T M?OR~ ?IACE O~ MJUR11.~ row. •.~r, s.~et*, ~.c+w.. LOCAt?Or~ ~~nen o~ .ro.. cm o~ ro.... s•.n ~ ~1rtU~t hf O~ w01 ONK~ ~e.YG.,~K. ~tMC~n~ ~ t ~ ~ ~ CE~T~~Kwlq~+- .wrtM w+ ~ ..o..n. w. .r.r .~+o us~ Sww wr/w1~ une o.. ~ we w w~ •~e~ ~w ot~~N otcu~uo .r r~~ .u.n. y, •,n /N~31C~AN: TO ~L itl~ ~„w O~\ ~ tWCt t~ OI~M ' ~WY~~ O~~f. ~w0. M Mf N!t ~~n~aOfO tM! ` ` O~ rf awpw~fOW. oN ~ ZI• o~a.up nOr ~ ~ ~ ~~I~, ~ ~ , ~ ~ v ~ fl1 7b~~ .~V~ t0 rw! f~uSfqr st~ry! CER11f~CA~IOW-/MfOKAI [XAMINiR OR COR0IYER. oti t~e W t~u aov~ O~ a•M ~~e oaew.. w•f .w.~ou..ceo o~+o ~~u.«•rA~+ O~ nV K.or .n0/M ~w w+~flK.~tO~. ~ rt Ww~O~. t ~ _ wOU~ ~ Of~M O(CY~~fD O~+ M WI~ .w oa a~~M C~Vlf~11 S~l/l0 ^ . ` ~ 7M h + ~ C[~TIi1ER-wWf rt.n O~ ruwn - i S A1WE y~ ! - nn~~ ~Si o.r s-rr.i, Charles Eytel, M.D. c~- _~t, ~ ~ ~ ^ N"'"`"°°"ss_`E~r°,~` g31 '~~'ti bve North t~a les F'rorida ~3940 6UttAl, C~EMAIIpN, RE~tpVw~ CEMEiE~`I OR ClEMAT01tY-IY~.vF .IOCAT ~N u~ o~ ror+~. s~.r~ ~ vec~.r ~ f3urial N~ Na~les_u~emorial Gardens N~ales, Flori~a O~Tf ~..o«rw. w., n.i, ~fUNERAI MOME-NAM[ AHO ADIMISS ~ Sr~Ilt O~ ~.r o..o.. a~. w+o~~, s~.n. ur ~ Dec . 3, 1977 ~n.P i ttman ~une ral Home ; 2116 Ol d Rl Road ; Bon i t a S Qri nqs , Fl a33923 ~E lp t wt R O REG~StRAal- S'GrtA~v?f ' owrt ~ECE.~eo ~r iOCwi ~FG~Stu~n ~ e r. 29'~i 7] - rir / ~~~/?u' ~ ~ )M i CERTIFIED CQPY I hereby certify the above to be a true and correct copy of the record on file in the Collier County Nealth L~e~artr!ent at t~'aples, Collier County, Florida. '(r'ot valid unless the seal of the Collier County Nealth Department is affixe~.) ~ ~ . , i~~ r I ~ .,t-~~~~~-' j ` Loca1 Reqistrar~of Vital Statistics . ~ ~ • ` Collier~County, Florida , ~ _ ~ - , / ? :klte: r~~i-r~v 3 gy: . . ~ 8t~~c ~Ai ~ ~~'i w _ _ - - -