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sat~~otFlo~aa CERTIFICATE OF DEATH ~
D~partn~nt ot Health aad R~luWlit~tiw 8~irvioes F L O A I D A ~ATt No.
V1TAL BTATISTICB ' ~co~st~~e•• No
TVPE OR PRINT A~-N~ ~~~f• ; a X TE A ~ rOr ~~r, ~
PFRMANENT ' ~ Roy ~ Wright , Male , Dec. 16, 1976
ElLACK (NK fACE rnrw. r~6~0. ~wetaN «yuN, AGE-uu w.n~ ~ n~~ ~ ~ ws OATE 0/ WM iro~w. w~. CO{JNTY Of OEAiN
ac. ~ wcr. ~ a~w».. nu~i~ ..oi ~.a ror.+ .r. .w ~
, , , c~ - ~ White 65 w ~Feb.7, 1911 Indian River
. . TOW~1. A N «~w~ Cw w~ MOSh1Al ?NE! ~ ~r rM w uwq~, 4M 1tM~~ w ~wu~a ~
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Vero Beach ?,Yes M Indian R~ver Memorial Hospital
- ST~T! Oi ~M ~ ~«o~ r v.f.~., w~re CI112EN MMA1 ~pk1iR~ MAlUED, NEVEt MAR~IED, SVWIVNG S~OUSE r+w, oM r~w« w~w ~
O i VKrs~
N•w«~. ~ Tennessee , USA ,.~a`rr°ie~ . Evelyn Gilliam
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,~.~c u w.w~ SOCuI SECUbT/ NUM~E~ USUwI OCN?ATqN ~o~a a..~ a w~a ww euawo ws~ a [wC O~ NlSWEiS 0~ o~0USn11
~cc~~ae.~ ~rowwa iw, Mw» NA~N~
~:271=12-5043 Carpenter „ Building
~ei~ae..U Np~!
.o..~~awn. ~ESIOENCE-S/AfE COYtJT11 GTtl. TOWN, OR IOCAflON w~ ta~ ~wn S1lEE1
,~lorida ~dian River ,,,Vero Beach '~;;`"'~'o ~y780 9th Street
/ATMEt.-N1AiMf . I~pt ri00U u~N MOT1~R-MAAEM NAME ~~qt rNM~ u~t
' Geor e Wri ht
g g K Julia Silcox
INWRMMIT-N~ME ~u?awfi AOOU4SS ~~~a o~ w., cm o~ ro.n.. sr.s. ir~
~elyn Wright -„~'780 4th St. , Vero Beach, Fla. 32960
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CfI1~~KwApi-n~ED~CAI E7t~Mr~ER OR tOtONER: o.. e.e ~.,s~s a ne a~•w~ ~w~ ~eua.n ~ws rwwo~..cu u
~w.r.•ao.~ a re w~..w/a ne ~+.es~w.~~a.. w~ praq~~. rOr~rw wr rw wpw
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CERbiK!-WUwE ~me o• ~«n • e~,.e oxe A D~+a+m, o+•, •u~~
~M Michaela -A. Tovatt ~ ~ ~ ' yy M. D. 12-16-76
t~~~~-~f~~~`+ 2300 Sth~Ave. Vero Beach, Florida '~2960
~tpnru. dtEw?r~p+. REMO~w~ etMttEtv o~ CeE~w?raer-~ tOCwnoN c~n w+o+.~. s,.n
~snere.
TransQor~ation #illcrest Mem.Gardens ~ Ft. Pi~erce, Florida
OwTE ~ap.nw, e.r, •a~~ Wt+ERnt NOrE-tan~wE wHp ~ppRESS ~ sra~~ u~ ~•.a., c b~, sun. ur ~
~ L~c~;18_, Cox-Gifford~8aldwi,n 95 2 h St. V ro Be
V .S. #612 iUNEtwI Ot-SlC~'~?iu~[ ' • REG~S ? ~ . w to ~r ~ouu ¦ isnwR _ ~ ~
~ew. ~i~e ~;c~ - l~ #595 K. e 9
"I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE
LOCAL REGISTRAR'S RECORD ON FILE IN THE INDIAN RIVER COUNTY HEALTH
DEPARTMENT AT VERO BEACH, FLORIDA."
THIS IS NOT VALID UNLESS THE RAISED SEAL OF THE INDIAN RIVER COUNTY
HEALTH D~P~~i?~~T~ IS AFFIXED .
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-rr., D P TY REGISTRAR I
3~~3~y
~6 AND RECORDEO
~T. WCIE COUNTY Fc,~.
A4CER POITA~S
e'K CIRCUIT ~OU
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I D !2 09 PM'lg
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