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HomeMy WebLinkAbout0589 =~71fr~f 1~WC~E 80Y TY fl~~ . . ~ / ItOGEI! ~01 At ,f~CIER~c~.Ai1ED COU N~r I1 2 ss PN'1~ , state of F~ona, CERTIFICATE OF DEATH I~parlment of Healch and Kehabilitative Services F L O R I D A ~TAT[ F~~c No . V1TAL STATISTICS pEa~sTn~n~s NO OECEw1fO-N.wE •~n• . .~eo.~ u~r Sta OwTf W OE~M ror~w, o~• • ~ Yi t c>H PFi1NT vE RMANENT ~ _ ~CHARD E~Al`IS TENER J Me~@ , A rii 1 1~ BIACK INK RACE ~w+rt. wl6w. aW~K~w wMUw. AGE--~~f~ v«oe~ ~u ~ o..___~ CATE Oi WIfN ~..w:M, s.~. .COIl~1i~ Of OfwiN „c sncr, ~ a~n.e•. ne•~s ~ ros w.~ . wow~ ~ w. t•w ~ r ~ ~ White s. 6 ~ ' 'w ! L Nov~26,,, 19Q~ I•. :~Sarttn Cmi. 10wn. O~ IOGT~Ow Or DEwM «+ae cw. ?w.h MpSI~iAI OR OiNE~ NSTITU~ION~- ~w ww ~w ~~wr~, a~n ~w~~ ..e »ur~~ v[crr as o~ ..o , St~ia:^t YQS ~~,r~tin Memorial Hospital Sii?E Ot WiN ~ w..o~ w Y 1~, N~r! C1i11[N O~ w?~~i COUNTItY ~+YWInEO, rKVER iWM[D. SUtvh/eiG Sr01lSE ~r ~N~ o~vi r.~. w.r tow~n? Wl[?OwED. WVO~CEO ~ vKr. ~ ~ , ~ • ~ Pennsylvania - - - - • U . S . A . ?~.:zz•r~ed _ _ _ F rancas ~ppenheimer . ~ M1'._ ~ SOCI~t SEC•rprv Nuw~t~ USUAI OCCWwT~ON ~ar~ .+.e o. .:wa so..i swnw wt~ o~ ~tMrD Oi M/SlNtii OR M~OIlSttr MONw4 ~MI. fYtM w Nf~~q ~ " 7U98 Ketired ~a.i,sr.i.stral.:.re Trasn Resr~ovai •IM~~~ ~ ' ~ _ ~ . Rt}~OE?+Cl SIA/f ~COUNTr ~(lIY, IO~MM. OA IOCwS10N ~s~ c.n ~r~ts SitEl1 A!!p ~iIW~E~ . . i w~cn. .~a w ro , i':l~r.~~.i~ ~a St. Lucie l:.. J:;s~SOn iaea:,t~ No ~a A- Veiit v 1i r R• ~aINlR -N~M( r.af~ +~OOU ~~f~ ~MOlIIE~-MADINNAME' ~wft - r~00~~ ais~ , N11Ti~:1~'P (:HAT~ .F_S T~.'.TH Td i~~ MARY - EGI'LA 'l~;NL.'k ~?+Wy~Ht _.NUwE - wKw+G ~DOtESS ~s~eu w~~~. .w . ew~ a*o.M. suw. ~r~ s 'rances ' ,n p_ ~ ~ r ~ . r~a~ ~ oEwm wns uuseo ~r: [H~e~ or~r o~ e~usc rt~ ~r+t wr t AF. ~w k ~ ~ a ~ M~rr~~M OMMt ~w M~~w q ~r.iwwi.wi i . NI -,'-i r: L,~ .T J ~ GL~ t . ~ : ~OMO~71OMf, 1~ ~M~ ` f ~ rw~<r p.v~ ~~u ~o ! (~1 ti~L ~Y,: ' 'j i. / ~ ,_,t_ ~Q~ " t . • ~r~uo~•tt uuf~ ~a, ` oM ro.0~ ~f • ,~Ke O~.- ~ •:•~L"~_ . . . ~ : U~1u~G ~w~ YM~!! f . ~ . ~~~NO C~YH l~Q ~ - - ~ + • ~ ' ~ ~ . ?Atl N OTMER Sl~i~tlfK/WT CONpITqN3. toMwno.•t cow~wwwe w p~a ~w .o~ a~.ne w cwa anew w rNr ~ wI1~01Sr K ~ES •~rr I~M~.Nr,s co« . - " . ~1~ O~/1 ~pf~MH~ ~M M/~~r~v~M4 C~vN . . ~ - ~ . ' . - - ~ ~ ~ M ~f~~M ~ ~ . ~ v Cy.:) .::.it as' Y~ :~'Iw ~ ~ - ' 1A ' Iw ?••~x.~ s; ..~DIM, SAMC~O! O~ AIF`~-Rl~i ~p./M. M~. ~~at ~ HOUf , . qpW tNlUit OCCUtR[D ~ bmr ,..ro~t p~Mwn r~n w r.N N, •n. H-:NK~Ol. Ot tMD4ttWItAO~ . . M la 7w r. 1Y irWRr i~t wOcic '~T-?a.~CE Oi N~u1r.. wr.•.w. u.en. •~whOn .~n~a o~ a~ • wo . em w ro~.._ sr.w ~ ~ ~ ~nc~r• .H w »O~ owKt M~O.,~~[ .srKrr~ . , : ~ 7M 7h ~ i tE[fMKAT1DN- .w..rM s~~ ~w rOMr wr uw ut~ yv Mw/wl ~~M OM ~ as/er+ra v.~w wy p(wiw OCCUNfo ...r r... ! /N1~K1/1M. ~OM/M Nt 1[N 10N ~„ff MaM IwOU~+ O~q, ~wO •r. w~. ~s•.' e~R~NO~O IM~ ~f T~ ~ ? • r - ' M Y~ tMfi~~l.r.~ M1 t n• oe.~.fw rro. `a~ 7 ~tb ~ ~'I ~ ~I~ ~7~.` ~ f11 l4~ ~-1a •e w.~ ••vw~~, a.n~ , CF~1YKwTICA~--MIFDICAI E7lAMMdER Cp~ONER p. nn ~•s~+ or r.y wqn o. a•e. ~K~p~ ~~f No..wMus ~.e ~ It.rr~~~~d. W ~M ~00~ ub/M A! Mn~ln6~tOw, w r~ Mw~~W.. ~OMM O~~ - •f~~, ou~ «cwNO o.. iw snn .MO ~w a me uvs~~s~ u.wo ~ , CE /RIER- NAM[ ~RMG~~w'_ - ISICsNA~UR(~'-'_ M rn . . ~ . • ' WGH~ q r~h~ ~AfE 1f.?MO •r~«n. C•• .t.~ .r~. Phili L. Mende:~,,t~n. ~ ' L-. / ~ r' . . ~ jr ?yirui:c woo~ss=c[iri!`~~~ 1----------_;~1.•Y~~.~ ~ ~Ih_~'3,~:1`1_ _ ~ H41~ W~~ MO CT p~q ~x ~ i % t ~ r ! ~ 1'~ , ~ . wawt. ctc,Mnt~. ~Mpv,u t~tFRr oit t~tµwto~-r+n,~ ~oC~ta~ n.. w.o~.. 1,... t 1 f~M . ( : J4 . _ Grematiori_. . -----~j N' Necror. C ~e~.;.~ari.~ra _ 1?!~ . _ Wes~ . Pa7iu_13e,s::Y,, ~ .i.o~•-~ c~~ ^ D~iE ~..p.~e». o?r, rt.~+ fUNERA~ NOME - NAMf ~NO ~fi0i(SS +~~u~ o~ ~ r e MO ,(II~ O~ fO~M_ ~I~t~ .~r . j 'M A 2•21 22 St i~ t.Y_ie~'c.a, f~ 3:,'•~) r. ~%li i? ~~1~~ ECT~f ~ ~ti~U RLC•~SFII41 S1GN~'L!I • DAIf ~ICIIVIG ~r H~~ qf ~a~~~• He:v //76 ~ n? ~t ' . sw A ri1 ~ 1 . _ . . f , ` { I hereby certi ry this to be a true and c~~i-rcct , .:~.,,;~•~r. . : ~°;~-=t;.,'g;~:~:, , copy of tye Lacal Registrar's record on fi le in ` ~ ~ 't~~~"~ ` the Martin Cour:t Health De artment in Stuart € . •:js.,f:. Y p . ~ . ~ - ~'=f~; Floriaa. i ~ `j t,i ~l'ti t~ ~ ~'yr . ~ • (Warning: Not valid unless raised seal of the ~ - _ • ~ t ~ . . -r ~ ` Martin County iiealth Department is affix~d. ) ' ~ r . ~ f' , . ; ,a,. ~ Archie McCallister, M.D. s . . S ; County Health Officer & Local Registrar ~ } . t ~t-a~-~k ~ , Date Deputy Local Registrar ~ ~ ~ ~ ~ ~BRa~i~ Z f S ~ {D ~ - x 2~~-~ ~-a ~ - - - - ~ _ ~ - '~~:z ts ~ ~ ~ ~ . ~ _ ~ •="c;.~,~',~ ~ ~~~~~`,.~~~x~~ . ~~..-.~'i`~"~_ _ . ~Sr`"v'~~~=s?:~'~ r - - ' Yn-~~a.' e+._