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HomeMy WebLinkAbout0061 401'715 c~ / ~T tita~P ot F~oriaa CERTIFICATE OF DEATH Ih~partment of ltcalth and Reh~bilitative Servicea lTATE s~~c ao _ _ _ VITAL STATISTICS F L O R I D A REG157NAN-9 NO OtCfASlO-NAM( r'~~ ~~s~ S[1 DAiE Ot DEAIN • ~nw~+, .~u ~ i ~ ~~t c~~+ PR~NT 'N ANTHONY II. COLUAlIIIA ~ Male , March 29, 1978 PENMANENT ~ 3iACN INK ~wfE .~.•n. «~aw. .•~ac... .n~u», wGE-~.?e -Tu..c.. ~~n.. ~•ron ~ o.. CI~IE OI {I~TN ~rO~~r, M~, CQ~~IiY O~ DEATN n~ ~ ~nca, ~ ~~~nro.. •ap~ ..os ; w.~ ~.orn , -.w •u~ ~ . White 63 r ~ ~j1uc~.30,1914 Martin -Z---~~_ C11r. ~OW1J O~ lOCA1tON OI DEA N w1~o1 C~n ~~~tf~NQSt11AI O! O1N[R NSf1~UilON--NAME ~u wo~ ~w ~~1W~ 6M ~Mf~ ~MS vuyN~ L ~ ~ _ 1?~f.~~ ~~a p MO l ~ n :+t~1c1Y'C yes „ Maxtin Memorial Hospital • ' _ . . _ _ M~r~/I.Onlr~MM~Yr1~ . . . ~ S~ATf (H ~tfiM No~ ~r y.~ ~.~r~ZC~t~ZEi~ O~ wnwt ~puwt~r ~ Mw~tkp. H(v(~ ?tARt~EQ, iSURrNNG S~OUSE ~ towar~ ~ W wtD. DIVOR O ~ WcM~. , New York . USA ~,~~arxie`c~ _ l„ Grace Lucido - . ~,,,.s.,, - - - - - _ - SOCi~i NCUe~tr ?~?+~6E~ VSU~I IX~u?~tK~ .c~.~ a..o o~ w~a oo..e ev~.uo rofr w k~?~D O~ ~USM~ESS OR 1NDlKtt~ » rp+a.c or1. fv~~ o nuqr ~ _ ~ „058-03-9789 Supervisor ,x I.I3._M. : .-`a. ^ tfc~OF?aCf - SfAl~ ~ rp1/NTr C17Y. TOMM, OR IOCAIIpN ~sai tm ~w~q ~Sittl/ AHO~ MUM~F• i - ~ ~ ~sqc•n ~IS M r0 - .Florida Port St. Lucie 1958 Avant ~ i ~ ~ ~ , ,.,St. Lucie ~Mllff ~N~M( n~1t ~uOpl i~V MOT11f!-'A410(HN~Mf ~~q~ ~MM~ John Columi~ia Florence U~•c:r.~<•F-• ~?~rORMwM-HM~t MAMU+G ~DOtESi ~u~~„ o~ ~+o. cK. d ro+r„, u.w. ir. ~ Grace Columbia I~ 58 Avanti Circle, Port St. Luci e, r~.~ . ` rNt ~ oEwm w~s twusEO ~r ~tHrE~ or+~r ont c~ust~~~{~ ,p~ys -TRZY 1~1~~N~W~~~ ~I~I~Y OM~ff ~w~ ' N r..rsu c~va . ~~~Z~- . ii~CER P01'(R~S ~/1 ~ (~1 ~ n i~ ~ . ~ ~ /7/~ . ~ i rr. N F:K 9F2 T VaT Y , M " ~o - - (OMDItIOMf, ~Mt MMICM o~vt us~ ~o i~l j__ i~ :I r i~~l n t~~ r w. . ; ~rr~p~~t~ C1Y{~ le~, N1~~OrMOwN[~ W. ~ ~ i ~7~~~M0 ~M~ YM~/~• , ! ~~IMO C~YN \wil / - ' ~ ' (U C. r c A R • ` } J; ~ % i: v r ; ~ N N - - - ?AtT M OTMEA SIGNNKAN~ COMDR~OMS: (O~~Mndtf COM~wY~'~+G M~t~en ~v~ wOt pu~t~ t0 U1M OMM w r~fr ~ q~ - AV~OIS? M Yt S+~~~ r...e~.. • ~ nt p~ Mp~ 1~e~~I~ ~M NI~~~Mr~rr. QI ~~~~M ~w NO !w P.~h~.e~l1 A(Cq[N~-SU~10( A~/U~tw. M~. q~~ ~ NOW MOW IH/Uir OCC1t~RE0 ~~'m~ wtyM O~ ~«~vn ~w r~~t ~ O~ ~•~r Mr • ~ ~~~~K~DF~ Ol V?O1il~MIM(O • ]N 7F M 1M . _ 1N1VRY AT WORR IIACE Of N1URY.~ wow. ~u~. s~w~t, LOCwT~O?a ~ ~~n~~ O~ ~.r • wo . un o~ ~o~rw. s~~n . ~\NC~n ~~f M MOI p1?Kf R~O., ~K- 1 VK~ 1 . 1 ~ 7L~ 7M ~f Ctlttlf~CwT~ON- noi+rs wr r~•~ ..o..+r e•. n.~ '•~o us• s~. ~u./q~ wu.~ ou o ea w++~t+ ~w o[a~N occu~~~o r..~ n..~ ~MtSIC1AN- TO ~ ~i/1 N• ?f~! ~00~ ~I~f~ M~M eMOVf 1 O~1~ •..r M~r r i~flw0/p tH! C s C: 00~1 M r. ~.~[ti.~~n o~~~.~~c ~K+. /!i A/i i /t J? r / 1 71~ I71~ /•t • /i A~I~ ~7 ~ ?h ~1!?R. ~7 ~'7 1II 74'~ ?f ~O ~rr t~oa~~~ . - ' - - ~f111UK~110N--M[O~CAI EftAMINER OR CORONE~~ o.a rw~ ~.~~s o~ wou~ or a.m ~MI MCIMM q~1 ~WMOYK~O OflO" r •t~rn~~rO~+ o~ M WO~ ~MO/M IMI Mr1lflfi~~~W~. M r~ Wwqw. ~~~~N . e~• ry~~ .n.r~ Nf~M M(V~~10 OM wN O~R WO ON M M C1VS~IS/ S~~tlO - ~y M. tl~ f.Et11RER NAME mq O~ r~~r.f~__.__~_'~_ ____~_,__~"'SIGNATU~f j ) nnr jhAf~ i1G?iEO e•. ,H itobcrt 61ews, ~~1.L~. L„=-~---- / ~ ~~i{;,~.~. ~ !,w ~ i+• n o~ o o t~n o ioa+w M~+i.+~~noi[ss-criru~e~ ~ . ~ 33~1'h4 ~I01 E. Occan liIvu. 5Luar~ FLoriJ. WRt~I. (~EMAt10N. tfMOVAt CEIMEif~YO~CRfA4AfOR?--N~titf . IOCAII(N~ c~~ rn m~~ ~ i•~c~n ~ ~ . Removal _~~~~St. Chai-les Cer.~eter Pinelawn, L. L., ivc:. ~ri~. -y--~--- - C~~~~~ nAif ~ ro..~r O?t, rfu fUNf~AI IIOMC- N~M( ??~P ~DAr(75 ~~+nn o~ e »o . a~• m~ow~, t~.r~, nr . - ' j,.. March 30 , 19 78 Johns F'Unera i Ilome 961 Colorado Avc~ . S tua r?, r t., . 3 34' J.S. #G12 ~1~+t1tAt~IREC70# SIGN 1UM~y IPfC.i51R~R:- S~i:a•~~r~[ oa~e ~tcn~~o ~y.~ n~ n.~w¦^ i~~V 7~76 ~7f?~'` ~~'f~ / ' / -L-~!~ 7N ~.~.1 Lt" ~ ~i ~"'S/~l.L~ 1M , ~ f I hereby certify this to be.a true and c~rrect copy of the Local Registrar`s record on file in the Martin County Health Department in Stuart, - Florida. . ' f~ ' , • (Warning: Not valid unless raised seal of the " Martin County Health Department is affixed.) . ' Archie McCallister, M.D. . County Health Officer & Local Registrar 3C~OK ~OU PA~f U~ - I "~-tV~- ' ~'C. Date Deputy Local Registrar _ _ _ , _