HomeMy WebLinkAbout0352 CERTIFICATE OF DEATH !
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Vero Beach Yes D.O.A. Indian River Menr~rial Hospital
STATE Of QlTM ~ e~ »o~ u~ v s ~~r~ CIi12EH 0/ YV1iA1 COUNT~11 wu~o. ?~v[e wu?ebeo. StllVNNG S/011SE ~w ~r~. one wwM w~re i ~
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.~u.~•~s~.~. , Florida , U.S.A. N Marr~ec~ Zbinmie Pittman ~
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v~ RESICENCE-SiAfE COUNT~ Cn1f. TOMM. OR IOCAiION ws~w Crtr ?rnf ' SitEET AND MIM ~
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~a Fla. ~N St. I.,l1Cle ~k Ft. P1P.rC7@ ~••Yes ~a 136 N. ZSY11 StreGt j
iAtMER-NUwE nes~ .uoeu us~ MO111E~-MAbEN NAMf nesr ,.~oae w~
~ ~s R~bert Lee Griffin Cathrine Shields '
INfpRM~1Ni-NAlNE . MAltM1G AODRESS ~frutr o~ ~.r.~. Mo. tm o~ ro./M, f~.n. t~~
Mrs. Zb~mLie Griffin 136 N. 15th.Street Ft. Pieroe Fla. 33450
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Crushed Chest Syndrome
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h'Accident 8-14-76 ,~2:OOp.M Auto Collision Accident
~ INIUR~ AT WORK ~LA E Of INJU~~ ~wre. r~u, ftMF. ~K~on. ' IOCATtON ~ fnu~ o~ ~.r.e. «o., an o~ ro+rw, s~~a ~
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i6 Plo ,~Street ~ Oslo Rd. and 27th Ave., Vero Beach Florida
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~i.~. Sc~ofi el d, Jr. , M. D. ~ _ 8-17-76
~~~I~flu~3~Ti'~Street, P. 0. Bo~"f1~? YPero Beach, ~r~"'~a 32960
~ ~URIAI. CRfM11110N. lEMOVAI CEMETE~Y OR CREMATORY-J~~uME ' OCw un w iown st.~e
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--Burial Ft. Pieroe Cgnete~ :w Ft. Pie.roe Fla.
~ D~TE ~ rw.w, w~, a.~ ~ FUNERAI HOAtE-NAME ANO ADORfSS ~ un~~ o~ o r.o., c~n o~ ro..., fu*~. nr ~
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1: ~i~ERA C)p~ =-s~;` f REG~S~R ~ LGNAfURE • DwtE R E~+10 ~Y ? q lf
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"I NEREBY 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 DEPARTMENT IS AFFIXED.
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