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Home My WebLink About0114 '~~r9~3''~i~? / s~~~• FIoMd~ CERTIFICA ~ c: OF DEAT~i ~ Ikp~rtn ent of llealth and Rehab{litaliie :4rrrices STAtF. n~ E?~o VlTAt, STATIBTICB F L O R I D A I R7 - - nECi~Tnwa e e~o TvPE dii PRINT ~ ~ -w~wt .reu 1t: o~~f t~ Dt?h~ ..u»•.. e.. ~N ~ t'lOr~n~ce M. Harle r Ft~tzle MardY 15~ 1978 oFRMANENT _ l___~ BIACK INK U1C! wq. M6W. ~~I~K~r n.H~w.~ •01-t~1~ w~e~r ~ Tv«~y~ .----'-T---- ------i---'--- ' nt ~ fMtwi~ e.. C~IE O~ 4~~N ~..o~.,.. rM~l~ M Of~1N ~~~~p.. . r~~N ~ wf ~ ~.q +wn ~ •a~ ~ ~602 ~ White w--67- " Z---,, ~----1' Dec.I5,1890_~~. St. I~~cie t~i7i; ~ Oi ~IFibi~~fD~ ' ,ri~i i.r. ~r..n MOS~IAI O~ O1Ml~ NSTI i0?+- H,wt ~ ~ .K+• ~~~w`~, c~~ ~~r~~ .r ..v.~~~ ~ ' ` N~(N~ M MO ' „ Fbrt Pieroe Yes 1119 Rasedale Avenue • . . _ - - - S A1 d~NIN ~w rp~ r CI;IT~N Oi MfIQt (pyNt~t µ~~~qP. NEvi~ MAt~1[O. ~ SU~vIV~X: SKfUSf rw .w~. e~~ r•+y.• ww tO~r~»•~ WDUWIO. CEO~fMtr•~ ~ t~''iA ~ « u: ~ Massac~luBetts Marri .J. lienry ll~rley ,~•~o r Maw~ SOCIAI S~C'1~fT~ Wl~~ ' _ NSUAI C~CCI!?A/~ON ~o~n o. .a~ ec..~ ow~~.c +m..d (aW ~N KKw+~SS M ~?UtKt~~ . . . . . • o(CVMI! rr ~ON+O ~MI. Mw NM~e ~ I ,~,„~N~. ~ „ 035-O1-Z201 Nq.. ~a 1~udit~or tiaskins & 5ells •o..sw« ~ES~oi?K~?[ ~ idn+tr 1 Qtlt. tOw*!. 00l/X~I~O?~ - +~~~w ~~n n.,n~ ~5nttt ir~p HU~~t• - - - ~~P~.... ~f.o~ ..n ,yFlorida ,N SC. Lucie Fbrt Pierce Xes 1I19 Rr~:~~xiale 11vcnL~ ~At~t._N~ . ?~W .yq~ ~~fIN¦ w~~IIN~~r~~W .,~P .qy„~ ~•o - „ t,o~uie a. nrc~,,m r~~ r~r,~tj~ c. ~ sct~.we~c ~ -M~ MAMNG ~bini~S .~a~~~o. ~.o • _•n..v . . ~~.a. J. ~i~ty HEUCley 11I9 R~?.,cxi:ile nvr.~., ~rt 1~ierce,F1 33950 ~ /1~T 1 OfA1M MA1 CAY3[0 ~ ~~N ...r~.~ :7~ii'.."~ ~lHff~ ClW r WX Catl.( R~ INt ~W b). ~?I. ~~~0 ~n~rr. o«p. •.w~ ~.w » -~M ~ o a (~sz'Lt~ ; --`-s ~_`,L-~- _ - , - . _ _ . ~ ~OMMIOM~ N ~M ~ _ I ~w~tr ~~~i n~~ rd I~1 ~ ~V. ~ e ~ V ~ ~ ' ~l+- ~ ` ~ ~MrlN~tt (~~f~ ~ - _ ' ' ' ' u.nw~ ~~n~- Fi~r, aTITrFe:~'ii~~'a m~N c.~N w~ _ k~_ fwtl • QtMI~ ~IONIICUq CONDIT~ONS• ~o.~aan co.~wso~.+o m.... ~v...c•~ n~.~~e ..vv •...n. • ~ ~VYVt• ~ w ~ . . . ..,,.,,,...a ~ii 4n.~~ 'w1~~~r.~r~w~.i•.~1~ A~ M l~~tw ,~A ~w wr~-~Ot, ~o~~M/(~~ r.. •~u. ?~o~~-- ----~wow u~N~~. r.ct~nno « ~ : - - « ~ Iw lk M 17tl' /MAlt~ A~MiO~R ~~wo~. ~~s. l~Mlt. ~~t~On. IOC~pON~~ .f•~u. n~ ~ ..o n.. n~ ro... ~~.n ~ - ~ VKU~ A~ M rOr awicl MN .~K ~fMt~n~ ~ ~ 7y CMM~CAI~OM- .~ou~~ • w.w •w u~. v.~ ~ ~.v~ .v.~ w~s.e •.r.. «w . ~NtfKuN: / 1O ~w. hu ?oo•.• • N•s_ Ol~tw t~~~fn w.~ rur~. ~w 1~t~IM~~ tM r ~r]Y~~ ! (,~~V\ •M', M M NS~ N«.u...o. 1-- ~.r L Ln-~- ~ rn 1 fq C~ ~ ~I/ \ /A O ~M I~VM~P 1•~'Ip ' " ' 7 C!/1MICAf10M-MEDKAI ~~AIMkK~~~ w r+~ w~f o~ ~+i r011~ M M~M ~r1 NZ~oi•w .~o-.a,.r:e e~: - - - - ~ . . _ . . . - . a ...o.. .»,a ...~.,b...~... a..a.. 1 .,,r.. N~w~ O( O~ M ~~M ,O wq t~qlH~ t~~~l~ ~ ~ m M CF~I~R~- ~ ~ ~K.?aAi1 / ~ j . ~1T.• • ~r ~O~(l~ Kd+F n.• ~ ; _ , ~y ~ ~A r~. • 1~ • ~ ~ ,n . 1--- f( ,n _f iM~RRKr ~ ~~1 ` f 1~ _ % ~fin ~ w ~ . e i- ~ . . / , \ ~ ~ ~1 v 1~ ~ r f ~ ~~u. a r+oN. ~Mo~~i t~. w ca~w?,o..__H.~x ~•I~K~fUM~ ` j S 4 . . veerr~ o. ~w C,t~ematiotl tn Fbrt Pierce Cc~~rter. ~ •~1 • a~~ ~ ~ M~. q?r~ IUII~RAI NOMI-t1~4K ~111~ If4~It_t ~ . ~ ~.Z tt r~. rCC: ~ ~l~r ~a~r3 l~rch~, 1978 Yates Flu~eral Itcxrr~, tnc. ,'1,~ .U. Pn:t 777, i•%~z-t Pierc~~,t•'1 33~;0 V.$. #81Z iWE - ~ j'~ ~lG15)~ - y-.rt~r~.e! . ' ;r,..r qr~~.~n t•xu rrr.~trr~~ n.~.~ne ' 'i ' •~_~.,,r:,_1:.-Fl~iccl1 17, l'~7$ ' ~ - ~ •t Y. 1 hersby oenify thfs to be e t~ue snd c~rect c v~ opY o~t tfie Loca ~ ~ Qepist~sr's record on fiie in the St. lucis County HeaUh Oepart• _ Rrr~t at For1 ~ierce, Florids. ' (Warning: No~ valid unles~ rai~ ~al of the St. lucl~ GoVntr Nealth Deparlment it affixed.) • t . . d N. D. MIIIER, M. D. ~ s Gounty Neal h Officer b L 1 ReQ~~rre~ FILED ANO NECOROED ~ % ~ - . st. lUC1E COUMTr fl A . ~ / ~ ROCE~ PQITNI?S 1~- . l' ' ~.-t~ dik-' a~ ~y R~~~~~N QIfRK C!RCE~ COL'R ~ AP~ 12 12 ~ s PM'1~ s~285 ii~ •?~8~~ . -~:aj . ; - - - . ~ ~ .