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HomeMy WebLinkAbout0913 - ~ ~S -1 l~ 3~ / ~O59~1 ~ ~ ~ CERTIFICATE OF DEATH neMHMewI ~ I~e.~llti aed ketiwl~ililalire ~ttvic~~ fTAT[ i1LE NO. ~ ~w~iw~~~~r~un~~u FLORIDA. ~r?!. O~ ?flHl IN M~~~YItlf40~~~1 RCGISTRAp•$~NO. ?lRMANINi INK ~CEAStD-N~Mt rutt ~+M~ ~~f~ SEX OA)E Oi OfAtM ~~ow~., e.., uu. ~ u~ r,?ro~oo~ ~or asie~crars , Cath;r o zrion ?'o ..or ~ Femal o~ dune ?1 4 IACE ~~t~. »I+M. ~w~u~r w~our, wGE-~.i+ v..w~ t~tu ~~~r OwiE 01 Nt?H i.w~», O~s. COUNIY Oi pEAiN. IIC. 1 WC~ffl •~~MO~~ It~~~~~1 r0~. M~f WN~f rN. ~1~~1 . ~ W}1~t@ s. z s~ w c yLt~ z Z r. ET'Ok~~2'(~ IT1f, TOwN. oR iouT~or+ a a~rH ..uw c+. ~r~u MpjMTAI OR OTNER.NSIIfU1Wf~1- ~u wp~ a~ ~Hrl~, crv~ ~~K~~ .w ..wua ~ ~t~ vuv. .i. c. Mo ~ Po~nkano Bc3~ch~ Yos 2464 i~.E. l~th Avo. _ ( S~AIE Oi ~1tM ~ a~ot w v s•. w•r~ UT12EN p wHAT COIRIil~ MAlR1EO. NErER MARRIFO, SUtvIVN4 S1'OUSE tw rue, on~ WIO~M IYJ~I 1 towm ~ wlDpwEO. ~~vORCEO ~ ss~c+? ~ ~~5~.`~~•~~ , I~11ss!_____ , U.S`A,_ N}farried Josa h A. Mon:ior ~~~~.ue - ~~.~o N q~M SOCIAI SECUp1Y NUly6E! uSUwt OCCUr~i~Ot+ ~wa a..e a.~wa oo..~ owwo ..oi~ a RIND OF WSINE~S Ot INOIJSItr ~ Cccu~~iD w M~O~I:NG U~~. f~tw q~tl~~l~1 ' ~~t~°~~~a• aM „ G24-07-6300 u. Su rvisor ~w Texas Instru?~ent Co. :eveu.[e uw~t r+sw~ em ir~n SiR(Ei /Ut0 NWYttft ~ o~'+~~ tES~D[NCE-S~~TE COVNn O~r, tOwn, at lOCwnO?~ ~s?tcu. ~~t o~ w~ L~~ ~w Floi•:tda Pr~~.-a~3 ~w Po:n no Beach 'le: ~~~2454 ~l.~. ~ 1 th Avo. fwiNER-NAh~E r~n~ r~oat w~ MOtMEt-~u~DEN N4,NE ~ws~ raw~ - aa+ Charles F. ~an I~.1r LE+e Sullira:? - IWOIW~r/T-?rAME MAIIwG ~OG~ESS ~sn~u o~ ~ i.e..a. an a~o..., s~.n, tr~ 2'x: Jose h A. N.~z~l~r 2itE~4 f~.E. 1''th A~o. Pox~ar.o Fc3ach, Florids ?ART 1. •r. a....r ...•t~.. • pEwM WAS GUSEO ~Y. ~EN~If On4Y ONf CwUSE ?fR lw[ fOlt lo?. {6~, arrO I~H n..~~~ o~~~~ :e•• 1!. r.weuw uvu ` ~ "Z'' • ~ , . . »ua, COMOIiIOM{~ 11 ~N~, . ~ •rMICM G~~~ •~S~ ~O (oI " ~rrte~~t! C~Yff ~0~, ~ q. « ~S ~ C7+1lOWK! W. ' ? sr~n..a r«e v~eu- ..~Mo t.vs~ ~.si (cl ~ ~wRt r OT,?~ER S~Gr+YK~wt CO?+Wiq~S eo~.o~no~+s eo.w~wun.w m w•w ~..oi ~wr~o w uusi e..eM r•,r a~ ~aSY ff ~ES ~+i~e ~~»~~wes co } , . . - ~~~s w ..o~ s~o~~~o o~u~...:..c u. ~ , o~ o~.~~ ~r ~ ~L , ~...t r ~~-r..2.~ Ilo 3 P..OcW~ 1 CGOENt. StuC~aE~R DA W T ~rp.n~, p~~, nu~ MOW INrJR~ OCCURtED ~~wna ..~rwE or v.w~s w r~u ~ oe ru~ a, oe. ?~qp~elc1GpE; pt tRDEftiA~WFO . ~ 100 :M ta 7k !r l61 INIURY Ai WORK ~tACE d WRAY wow. ~.a.. fnar, ~Kan. IOCATION ~ fnen oe u.o. MO.. un o~ ~orM, si~n ~ - - I t1lt~A t!f W w0 ~ p/K! MOG., IK. ~ YKN~ 1 , ' ~ 101. Kf _ ' . CfRT~itCwiqH- ra.+M w+ +w ra+~ o.r ,e•~ 41i y~r MW/M~~ •uq a.. , ap/.~w wr fa. me ot~rH OCCU+~EO .r n.~ r..~~. y. --c ~MiSKua: T~ ~OMM O~? qN ~OOT ~~~lSyrnw ~«oun ,3 o.n. ~~o. ~.e . 1~RIMMD LMI 6 2i 74 fa ZS 7.3 a.. ...o..,Y- Ottl~S1D q0.. ` ~ 6 e so ,o M~ ~...u... , ~ CE~TY1UTiOrt-M[O+CAt ExMUNE11 OR COROt~[R o•. r.e ~•s.s a e.~ .p,~ p~ a•n, ~M~ O~CfO~Ni ..s no..pu.Kto o[•o ll~rlM/~lql~ d[rM ~Jpt ~rD/M t~q N~Yl1TIG~iqN. ~w • p~WtpN. . YO~~1M O~t fl~~ MOY~ Ol~M OCCti~tfp W ON Wt~ u.0 OYt ~O ewt C~VSI~S/ 1t~tf0. ' ~ ' 77~ ~ M. m . " ~r . ' CEiniw"R-wM+f ITh O~ /FMb S~NAT OlG\l/ W~~ne DATE SIGNfD"~~o~TM, C~r .ta~~ Di:ane ~:~h1~3n n. ~~1~ . ~ - 'J- -7 r, i ~ ~ ~ s~ao o~ ~~.o ..o. un c. w.... sr.n % ~ N1l1NG. t S{....f•G`~SL~1 Jct?'.^.Qt. Ponr,'1T a 33~..~ l~ ~Ut~AI. CREMATqN. AEMOvAI Ek.EtERr pR GtEw~ATp~r-NM+E tOGTpN ~ t~n o~ q.... s~.n - r.~~ ~ vtcrr ~ ~ ~ ~ ~a H,_'1~~~~~~11~~~~1'. r.. ~~no Peach~ F~ arid3 ~ DAiE ~~a+*w, w~, a.~~ FUN[RAl HOME-~+A~ ~roD ~OOtESS ~ fnee* o~ ~ r.o ..O . On p~ ro~r, s~~tt, tv ~ 7u ~LL':£!~_ t ~ ~ ~i I3~ Fi~ ird-Ca:'. B.~'' ~:^t ~~a:.^. • ~ :i ~ j'' CU~ i. vs Pv."".. ;i?20 FJ3? C21 t 102'~~ 3 @ Y• S. /672 ~UNERAI DIR ~ SrGNAtUf~ REGISitAR--,ty~rufy iE ~f t~~ ,~1~ O~~E![Cl~r[D ~t IOC~~ qG4n.¦ ~ Re v. 19T0 tA /?A~j~~ •P • /:•'3 1w I':.CL: f t c%U:.~1.~ ll.~''+~+'c'~il~ tu ~~2 ~~~~i ~ # ' ~ ~ t i CERTIFIED COPY - ~ ~ I tiereby,.cer.tifythe below to be a true and correct copy of the Local Registrar's record ~ on ~ilg ip;:the~~bward County Health Department at Fort Lauderdale, Florida. ~ ~ ~ . r2~!~f ' <t , . • ~ ~ ~ ~'A D ~ ` ~ (WarniAg;~'_Nut~valid'iihless raised seal of the Braward County Heal Dept. is affixed.) - • ' ' { - i11E0 AMD RECOROEO - i~~/"~"' ~ ' . ' ~ ~ ~ + 4T. WCIE COUNTY FL~. ' ' • • ~ - - ROGER POItRAS ~ 12-3-75 Lj I . -^:_:RK CIRCU~T CCURT un ea t cer an oca egistrar '-i''~st:; -c cttf~ , i • ~ ~ ~ ~UN s io 45 aN ~~8 pu y eg s ar } ~ - _ . - • ~ t } ~ ~ ~~~~~f~~ } ~ . " ~VVR MV~J • ~Lfi t ~r ' _ . - . . . _ . ~ ' . " . de'~:'-±