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Home My WebLink About0282 / 4US5~3 ~ DEPARTMENT OF HEAITN ANQ REHABIIITATIVE SERVICfS STATE OF FLORIOA DIVISION OF HEALTH ~ Alachua County Health Department . TN~pha~ (90~) 37&5321 S~6 S.W. 4th Avww~ P. O. 8ox ~3Z7. GNn~svilN. Flaida 32602 > ~ CERTIFICATE OR DEATH Ok~wwewl .f 11..1~~ ..a ReL.W+aMw S..Ic.. t~rATS Ilu Ma , . F L O A I D!l ~~o~sTw~~•~ Mo. ' trn. o~ r~~ +N M~MA/NN1 INR ~E~p~N~ us~ ~i OA OEAM 1~M~w, Mt, aw~ SE1 NN~IOM fN I~~ ¦Slw(110~i ~ M Zl//N~ t. ~ l ~ACE ~+w. ~~o. wMCU. w~w+. AGf-~.s~ wse~ v~~ OA~E p MRM ~.o~+~.. w•. C011M111 p OtwtN tK. ~ VK~ ~ Mwy~~ ~~f ~ rOf. M~f ~f rr~. w~~ ~ ~ ~04 ~ Wlu.~e / A w . Oec. 2~ l881 Al,acl~ua , T lOG?t10N A r+s~ cn. arr~ NOSMIAI OR O MSt -M r wo... NMp. Nw t~•..~ rww • warr~ /qt o~ .o ~)~~~t~~~ r ~~j j~ • l~. ~ P.~1/,(i(~(je h. 7 P.d N l1tiRCJU~i~yuay~C/~uti 7/O•4 ~ f SiA E OF Wlfl ~n Mor w v.f.~.. M?r~ U11ZEN W/{~T COUNI~Y AWMED. NEVE~ 6 O. SaOUSE •w. ~.n r~?+w~.wwr~ - coww+~ W~O~CEO~Y~c..~ 11. /~YIU11i.e .JIlIKrVi vfuu nfeaM[t ~pj,(/j,~. • (,(,~1I1 N ...e.~ sece.~s SOGM SECU~it1t M~M1E~ USUwt OCCWATIOIi ~ a.t a.N o...wa ea+~ ewwo row a RwO Oi waNES9 011 MrDUSTitI l~v1p. M NaM M~k~p ~y~~ ~11lN tl!fM{O 1 S ~ O(fYNfO W ~ ~hf11~~OM.6M ~ ~lY~.~. W.a. I: ~6 ~ O _ A1eticl~aie.~E - •a.ufs~w. RESIOENCE-STATE COIRRr ~ . CRY, tOwN. O~ lOUT10N r•we c.n ~r.ws STltEi ANO MW~E! ~ • • , fYlCw~ nf W NO ~ . • eav.i,CLe tfee ~a 0~8 ' P INF IN IM. fAtMEf-NAMf ' ~nSt . r~001t t~f~ MOTNE!-F41OEN NAMf WOOU uf~ I1. !I • ~ L.~~R 1~. ~ . INFORMANI-NAMf MAKA'1('i ADDRESS Ifht~i p~~~- MO., C~h O~ Mw. f~~M. ~od.~ W.i~l,l~~am~-Tl,,orno,e F.N. ~.0. Qvx 0 ' F' ' ~11q~~rMt Iw Y . .....~n ~~urn ~v,~r [y~s t~utc ?N IMIE FO! ~eL lbl AI~O un.w srs~r ~w w~b : - 1~. V Iw~lN~R C~Yff ~ ~ ~ . t • ~a, _ . Lf . . ~ ~ ~ ~~iMr~r~'^O ~ i COMMl1ON1. 1~ ~M~ ~ ~ v• j wMICM O?t! ~If[ 10 ~S~ • Ir~lM~tf C~YH 10~. 01N 10. O~ ~i ~ COMSlOYlM[! O~: ~ ~ ~ st~nwo ~w~ YN~lM _ ltIMO C~Yf! l~lt • ' ' " ' _ ~w~T Oi S1G?~MKnNT CO~~IWiqNS: ca.aea+s canwa. m aw »o~ nuno ~o urse ee.tw ..nn ~ w ~ i YES ~ae ~~«~~..os eaw- _s_w_b_o_y_~_~_~ ~ ` ~ ~.t~( ~ ~1~' ~w~ o. «o~ a iww wn~r.....w cwu ~ ~ ~w. ' ~ _ ~ ~CIDEi O~! IJND~tEW ~ A ~ roMn. e~~, ~~u ~ MOI1R HOW IN1UfY OCCUtRED 1 t~+It~ ~uNIM O~ MIYt~ IM ~Yt ~ M?~N M, Afr ~H M . 2M. 7k M. !Y j INIURY AT wOt': MwCE Of WAl~l/ w~ wr. r.~r. s~~ee~, racra~. LOCw110N t N~M W t.1_O. MO., un o~ wwr.. sr~e ~ ~ ~ vwn .n w..o ~ o..~ct reo.. uc. ~ s+acr. ~ ~ CERTffICAT10N- ro..tw ~+r reu r[wm 'wr •ta~ u» us~ sar wr/wn ~uve oM ~ Mo/ wt ~n~ 0lAM OCCYtIlD ar tw rua. a~ w~ ~ ~ ~ ~ ~ ~NtSK~~M: . . ~~d M1 ~!Y ~OR . /~OY~1 MR. I~M. q O'! Mft i0 t A -f • p r1 wornloCt: OM we w 11a ace~uoiw.. O Z S~ 7~ 7t~ 1 7 / 3 flc ~ ~ 73 . 1N_ ~ tM. w w~e ewvse~s~ st~w. ~ CflttlfKwT10N-ME01Gl Ex R OR COtONE~: a~+ ne uws a r.e ~OW W Of~M • M! NCMlM M~! ?~ONOYMCtO 04O , eu.....na. w a.e ww u+o/ me rwes~~e.ra... w awa+, w~w occu~+eo w~e own ~wn wie ~o ~we uusea? sune. ~ O~ 4~J t1~ w' 73 ~ 45 M. ~ ~ CEt11flER-NAME ~nn o~ r~a+» 51GNA e w mee A O a~.'~~ n.. Daniel B.Cox M.D. - • ~-_-11111~~' MARING ADORESS-CEat1fER srn~~ o~ ~~.o. ..o. cm w~o~+ +w Fld. ~ 260t swn~u. c~w?ta?+. ~Movw? ~icR,r oR cunu?iorr_r~~ ~ouTwr+ QOV.4c.c.e I'.~O/tU~LL I VKM?~ ~ tN. ~ • N+ ~Id~L _ r ~ro.nw. wr, nu~ fUNER4l HOME-NAMf AND ~DO]FSS ~ srn~~ w a_r.e. wo., tm o~ ro~.w, u~n. n~~ ~ QRt 2 n.. ~ - ~ PitV ~ t r~n 3~~11 / Y. 161'1 F' RtGIS(RA~t-51GNANtf ~ . OwtE RtUWEO ~I ?OCI~ ffG11TL1 , w n:. Januar • 11 1973 R~v.19T0 ~A. 'y 3~-.------------- - - - - - - - , . 'in ~ . ' ~ ; ' I HERE3Y CERTIFY THE ABOVE TO BE A TRUE Al`D EXNCT Ct?~C~OF TQ$~~EATH CERTIFICATE FILED IN THIS OFFICE. ~ ; t~ ~ , ' ' - ~ ~ f,l, ~ ~ ~ ~ - ~ ~ 4% Q~ . ~ ' rE • MYRTLE . TRC~WELL, DEPITfY REGISTRAR ~ ~ c~ ~E~ R~4~ ~?aiE ~a~~T~ ~ocER ao~t~~s ~,=ar. ~.~R~ 43~o C0~ ~ i2 ~2 ~H ~~p s~~~ 288 P~~r 280 i 4055~3 ~:.M= .~,c - • - ~~:~_:,.-~,s. .!a" ~:f',rn. ~,r'~i'.'~f S9 .