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HomeMy WebLinkAbout0069 + / ~ 4U920'7 ALACHUA COUNTY HEALTH DEPARTMEM' ~ 816 S.W. 4th Avenue GAINESVILLE, FLORIDA . ~~k11n 2-9541 Edwo~d G~ Byrn.. M.D., M.P.H. `~`7 Dirxta P. O. Bax a'CU- /`/'J.,f/r sY~Te ~owno or Mu~ni CERTIFICATE OF DEATH BURtAU O~ VITAL ~TATIf17Ct lTATt Fltt NO. - FLOaIDA R~R7M NO. ~ RC6lSTRA0.'3 fi0. 1. rUtt O! O[ATM CODC HO. 2. Y1UAl RC110~NCC(~l~.~I~r~dA..t. J/wnn~u.~ It.dw~.?H~..e•.;...... CC.`1Tr ~ STAT[ 0. CQ~:~7Y ~ 1].-04S A ST U;C 1 E C~Tr. TOMM_ OII LOCATiON t. R IIAt[ O~ D[ATM C~TI. TOwu.OR IOCA~qw . t. :1 teC,i_i ~:E ~ GA l t~ SV 1 LLE ~~~r°~cs ~ r~~o O FT. P I ~RCE ' ~ ~ y~ G'-•,,~.~ f. A~v[ 0~ (1J~t 1~ lup ~t~t.~ t Myr~ ~f(rrV) LEMGtN pi STRC[T ~Oqt(SS ~ . ~ ~ov~r~t at u(11 VCi'S IT Fi05 Ita ~ s~r ~ oM a r~aw. :"S~'T°~'°" - ra' 1~:on~~i oute 4 3ox 10 •~SC 3. Nw~tc or firt AillQr Lat 1. Wtc JVe+~t~ fl~r 3n•.---•- occzwscs os c'tiY'• ~''"n A!. A FSA~ E R iCFiARD50N CCATNh~ I L 9 19b5 ~ S SC% ~ COICR OII RACi 7. MM~KO MCYEII MA11RQ0 MT[ Of ~UTN ! aG[ Ne ~~aq V PuCR y: la: •6 _v'~:. 8 ~111 ~ 1 Q i•~rCh 27 1724 l~+~uf~1f~I) N~.s4 INw Hwn 1 X.a. . e' MID01Y(O ? CrrORC[O ! 1 I i:q ~SV~I QCt~~ATqN (Gkt t~~l~f rwl Mwt 1OD. fUNDOf ~i1S~!~ESSOw ~~DU3TR• Il. /~I1TNK4Q (S7~ff ~I /srty~ eN~~h)) 1. pT~tLt O~ w~u' (,a,v'a~ t (a•(~? ne~t Jra~iw~ t~/t, ars 1/ rrfbN) ~:oaser~~~e . Floc~(da Ifnited 5ta~es ~ . . _ . : = It. IROTNCR~S MAIpEN 14M( • Sen Ciola Anna Rarie Eernardi :S x?S DLCL~S[C (YCR th ti. 5. A11MED t011CES• 1~. SOCUL SECURIT? Np. 17. O~ltl~D( C T• /~~y/) / ~!'.~.~r.i•~iw~ 1/lM..~.~rwrNY~~~rl ~•I~u~L(~~ I\ ~ ~ ' . r.o 266-24-7359 wr.. . s Un i v~'b3 r~ ! T:: ~ r;~ f i~ i'_ eAUt[ o? otwrw (Eere. ~nt~ ~wt «we r Gv JM (a). (A). t(~:.) t.r. cr.vat t e i:; C"~sET ~wa ^:tiH • . ~~~T 4 O[~TM t/~5 C~~S(O trx ~MyEW~TC C~USt (s) _ . C ~~,yL~ • t C•.t~r~..~. E/e~r. ouc ~ (A) / ~ . e~lid rer~ n~s r• ~ - - - ~ . da?e nax fi). atdi~/ t~t •eGr. 0171 TO (t) Z i~is/ t~aK fstl. _ ' O ?~117 17. OTM[lt 5!WOKJ~Mi QOtIpfO~t3 COMtfIRlfL~C TO TM ~Ut Ibi RM7CD i0 ~M 1U~r~W S[ COh71TCr Gn1M t'1 ?/J~T 1{~) . w11i ~l:~vaSl ?C~AciGAMi.'.~ ~ •Y[S L. NJ = 7s, ~ •s aoe aseRiu ~ow uuu~r oeeu~KEO. tEara ¦rr.e pu~ l a pve lt./ tr~. u; ~ y AtC~~[MT SU~CIDE MOYKICE fv ? ? ? 1~ [''x ic~E OF Nnr McwU, Ds~, Yr~ _ 1 ~ ~wwr 1~ y.a. • 2:1! i~l~\v OCCi:RPCp 2Dt. ?UCE Of UWM (f. L1 M tlbrC l0A[. 7A/. dTr_ TOwM.011 I~CATqM COVhTI~ ST~T~ ~ M y'LE ~T Q MpT MM1L( O JVA. J~flOh. /~~fd. ~~lf GI~.. t(t.~ ' ~C4K ~i 7YpRK :t l.rt~n/~c~~ M deceu~d /rom 1 :°uT'C~'1 ~ ~ 1965 , eoApr i ~ •n01ut ti+ Afm ~li.~ on 1 ~ ~ ~QritA bceutr d~~ m en fM d~ ~ ~bf~d ~Ae~~: .~e r. rn. a,~ er x~o.•~.e~.. i.o~ ~n. ~.~~...u~ed. Ij . . ttG ~ ~4`.- ( a • f / ?.ZA. ADDIItSl ?It. GT( S!~r L.^ b'~ ,'1,! ~ Gainesvil],e Florida - / ; - / ~ y ' ~~Y_ 2~t~~i. CKr~Tq~. jJ~ DATE 2Jt. M4~ Cy'f [~ET[11~ Of! CR!~~~pR7 IQ~ATItSN (C~Y~, 1lKA.OI (ya~1 1.~~!i • -r..~a: f 1Zv~:ti1 `s ! ~e~oval 4-13-65 Ft.~Pierce Ce~retery Ft.Pierce(St.Lucie)Fla. _ : ~~-~EP4 D~~iCTp~ S SiL9\7LR6 ~ SS 75. OATE RECD, ~T ~OC4l, REG REG~57R~q 5 S~GN~'uRE - f • 1-- ~ 902'°is . 7th St. ~ " ~ ~<.i? F e Fla. 4 15 b5 ~W~ ~'-c~~~w~%C ~ ~ ~ ~ ±:__?;3v C~?:IFY '~EiE :+BC~rr i0 BL A TRIIE A,";D ~}C~CT CGPY OF 2~i~ D~n'i~; C~PTIrIC;:i: . ~ _ I:d `:~:IS OFFIC~. ~ . . ~ . ~ : • G2L~~ rGND ~ , . • . ~ ~ ' CC;u'r1:Y K~;AL`I~i Uf~'FIC~:.~? d I~?C~'.L F~.'GZS'TPr.~. ~ _ ` v • ~ - - fiLEO AMD dEC~NGE;: ~ - ST. lUC?f L JUN ~ t e Qu,_ . ~ ~ L ~ I~fi,P.l,.? r, - _ f . . ~ . ~ D i; ~ ~ UPl~ la , _ ~ ` . , ~ + ' • ' ' ~ l+ fEfiO vr n0 ~1 _ ,Epo, _J~t l ~ oz P ~p. - . k~ - - - ~ ` ~ v""~"; r ~ f r.. ~ r- - 4U920'7 ~~~r~ ~ ~ ~ . °f r~ ' ~ I ~ ~ ' e:~s ~ ' y~:; 6F[NC[R 0. GI6B[RT. ATTOIlN[Y AT LAW. 220 fOUTN ~[COHO 6TR[R. FORT r~[RC[.'LOR~DA `y ` ~ 4 j= ~:tTa r ~ . r ~ s -~M F' .~5~`~u'~r'~.v t .t-_ ~ ~~a`' ti ~ ` ` ~ . _ .~.x~~~~2 . _