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HomeMy WebLinkAbout0590 4U95S4 ~ . ~ CERTIFICATE OF DEATH I~d~ew~ d Ik~l~l~ ~wa k~~.{.Ilil~lhe ~rrd~~~ fTATt FIL[ NO. - IN\KMM~~M 1N.~IIt1 FLOAIDA tr?~. O~ ~~INt IN r~'""""'w•~O"~ pt61tT1~A11 • NO 2~~ ~1\M111MNf INK OECEASED -M4Mf •~~r .+w~ ~~tr H• a~.~t o~ of.+m • rOrlr, 4M ~ kl YM~001 10~ '~""10" ~ John3on t , t 4Cf a~n. ~ee~o. ..~~«.r ...e..~, •GE -u~. .+a~ ~ nu ~.ee~ . • C~1[ M WtM ~.o.wr. COIMT~ O~ ~/N ~K r 1M<M~ I . ~~~wNat ~ r~~~t~ ~ r01 . M~1 ~11~4 ~r 1 6602 ' P~ack w__~ ~ ~D~~,.~2 ~ _ 1904 St _ Lu~ie ~m, iow?i. o~ ~o~siwi+ o`~$i~ . c.. ~rws ?qSM~I O~ OM[~ NS ttYT~+~'-H ~w .o. ~n.r~. cm ~r~~~ .r .wwn ~ VlCMI O~ r0 . - ' ~~ort ~.~rc Y~s__ N ~q_ Ft,~P~erce__t•iernorial _Ho3pital • SfA1E Or M~M ~ r ror w~~.., M..~ ~-~€H d w~ut cdMnr Wlt~1[0. N[r[It AtR~lKO. SUIWI~iNG Sr'OUSE ~ r.+~, eM .uon+ ww ~ cOww. ~ ~MDOM~FD. WrORCED ~ vKV. r ~w....~. ~ Geor,gia ~ u~S.A » l~~r~ed __j~~ Henryr--JQhn9on_--- y~f N(~~f~~ u~1~ r N~w~ fOC1A1 S[CIJbiT M/M~l~~- -V" USUAI OCCU~A?UM ~ Ww a«~ M~Ow ~o.w MMwo +of~ W ar+o d wsn+ess o~ wannr ~ OCCYMf~ M rO~a~4 ull. MM M NMN ~ K «o: ~t ?.~7.~8 1024_ , t' c Iiouse_ ~~life ••••~•••o• iis~uu.ct-sua co~n+n rnr. r ow?.. oe iounor+ siae~ ~e~u ~+`u.:~~"~`-- ~wcr. o...u u. ?a ~w /~t?11t-MAJrE rrpr ~1~1f uu rQf?t~-MddM r~,UM! +~a~ .wH u~~ r.e s fMO~MAM- w~41?A 4DWlii ~swn w~~• «o. cw~ o~ ror... s~.w. tr~ ~h IA ~ ~ ,1 ~ARt 1 OfAM vYAt CAUStO ~t: ~tMTE~ OM? ONt C~uSt rt~ 1N[ rot f~~, 1~1 n?+O kM MMfM ONNI ~M M~M N . h~ rtensi~e Arterioc2erotic Heart D e p A~ ~erebral Hemorrhage 15 monthe ~rMM~q UN~ ~M. ~ M q. O~ ~ tOMYOMM[~ O~: ~ ~t~11N~ tU~ rM~N- - Itrw~ t~rN U~t ~AtT / OM~ S~MKAN/ CO~AKIOMS (OwF~Owf (OMMNw6 10 M~~ M~+W Mu,N q U11M 6Mr w. iw . ~n ~YtOKt r rES ~U~ ~IM~IMi1 (OM~ ~ w~ O~ nOr M N•~. Np~r.nM~ ~afN Jedceonien Com?ul~iona ~ Of~~1/O~t~MMMO ~~rw. M~. n~~r NOW IN1Wf OCCUMEO ~~w~~ wiw d M~Y~1 IN 1~11 I M~ut M. ~It~ ~ ~ fA 7M Y AI IN~lRt Ai WOtR ~0+~. ~~M. f~t. ~~tb~~. IOCA110N ~ fwf~t O~ MO O~ W~M. p~R 1 1 flN~n A~ M+O• Ow~t~ MM .!R ~MK•n~ . ~ ~ ~ ~ CEf1ilUT1ON- ~OM~ Mt Au rOrA Mr n~~ ar~ u~r Y~ .ti/rH N~+! O~ ~ ~ao w~ .~n. ~ N~n~ Mcwuo M MCl. O. wA N~~~.'~':0 2 6 75 '~~N 4 30 T6 4-30-76 .a. }-«~=SoA.. o~:`~:~":' ~[f~MKAt10N--MfOKAI ()AMAf~ t w Me uv'~w ~.r ~ou~ w a.n. r.~ Ncner. ~ - ~a....•ti0.. d .~f os. .~w~d .w ...~~na..o.. d.nw. ~ occv..+e o.. s.a mw .o ew c.rwH~ ,,.h. ~ = 7~1 r7~ • ~ ~ _ ~Q A . M. M y M q+n1-_ 'TSA~ D C~t1dK~-HAMf ~~m M rM~ ~1 iH- A~li ~ ~ +r. ~tu~ C.~.Benton }r- - _ ~ ~ i~7 =r ~ n, a . .b a :a.. ;w"~.~ox`~~ ~ L2h N.9th ~'t.` Fort Pierop Flori~a ~I1f1Al. (~~MA/10N. KMOVAI Ctw~Hr O~ CRE?u~rotr --~aua I~AfIQN (.n p Mrr f~~~f I y~( M • Burial t„ Pine_ _Grove__Cemetery__ t~~___ For~_P~,erEe____~___Flor~~l~_ D~TE ..rr++~. c.• H~\~ . . . IUNE~AI NOME-~+fW .~7~Tr ti'"i.ZS; : o~ e .o . o.. w ~o..., f~.n. ~~r. 1•iay ~3, 1~7~?_ _ ~~._~tone i3ros 1 1d th Ft Pierce Fla. 33~50 v. S. ~b 11 ~U?+E~al e~RC~O~ -~:'+~~lM~ n(G~} t~ ..~.run , o.n ~an+fo ~oc•~ ~eGnnu ioto u f u ~ ,N Ma 7, 1976 ~ Mreby csnily~rhis to be a true and corren copy oi the Locsi Registrar's reco?d o~? file in the St. Lucie County Health Dspart- ment at Fort Pie?ce, Florida. fItED ntiG ~ECUhJE:: (Warning: Nof valid unless raised seat of fhe St. l~cl~ ST LUC1E CO;;NTY fl~ County Health Department is affixd.) R~ "U~'~~?~ ( ` . ^'.CUIT CL1, _ . N. D. MIILER, M. D. p . Co~nty I,aealth Otfitet d, Lotal Rsgistrs~ : ' J~J~ 3 2? I H~{ R ` ~ 7 ~ ~~r ~ ~ ~4'~l~r-k . Ut-.: ~ , Od~ OdpUtp ~OQI ReOictr~? ~}09554 . . , ~ ~ ; . , - ; • BU01(l~~7V PAGf 5JV ` ~ - - - - ~ ~ ~v _ : ' - _ = - - - a..~:~...~~r