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HomeMy WebLinkAbout0258 t ~~u~~Y fi~ acEp Po~rw~?s f.t faK CrtCU~T COUR > Auc 15 10 ao AM'76 ~ . ~i4s25 Palm $e~,ch C;ouiity 1-~e~.ltli ll~p~.rtiiieiit • t ~ ~ s~,~~ ~r F~~~~~~~ CER7IFICATE OF DEATH Uepartmenl of I lcalth and Itchnbililalive Serviccs F L O A I D J~ sTATE si~t Ko _ ~ ~ V~~rJ~~. ~•rnTisric~ . ~ REGI6TRAq S NO ~ TYC~ OR PRINT O!ClullO-~+~w! •wa~ • ~~ti~ SE~ OAfE d OEAtH ••o~r., o•., ~ GGO1tG[i C. i1M1Nf:R , MALF. , SFPT!':AlBLR 15, 1977 PERMANENT ~ - _ - - - - et.ACK INK lACE ~..•n. w~tw. ~weur. AGE -~N~ v«m~ ~ r~u v..o~a ~ e~. Cwlt d~~~M ~ ~Ortr, C~?~i~ ~f O(A1N R nc . s?~c.r. ~ ~,u.e.. ..o~ wn :~w~~ ~ ~~u ~ q PAIJ~1 BE~\CN . WIt1Tl: ----I,~ _85 _ w . 3-2U-18. 2 ~ ~m. rawr,: o: iocw~~o~+ a oc.~M w~w~ u*r ~~..n MOSMAL O~ OINEf NS/11UtiON-?~,W ~r .w, ur»~~, am »wh ..e wwrn~ ~ G O O ancw. o. »o , . , n !'Ai1~t BEAC~l1 GARi)E;NS YES PALN R?:ACtI GARUENS (.~(N~9~tUNITY 1fOSPITAL ~ - - - - - i~.~ SIAiE O~ NRM .ot .w Y f.,~+.~•~ CITIZEN O! vVHqt ~Q~~NTRIf MAfl~EO. NEvl~ Mwll1E0. ~ SINvHl1('i S?Ol)SE .N~, c~v~'r~elr rur~ ~ (O~n+n~ ~ ~MNOW(0. OtVORClD ~ WCrr ~ ~ ~ k?~~• ~ V I RG 1 N I A • ll . S . A . - - - - MA{tR 1 ED - - - RU7~ 1 CI iMiBERS - +MM Of;1?LO ~ . ~~•~e a•+n SOC~~?t SECUnir t~Uµs[~ USU~I OCCU~~trO?~ ~u.~ ar.e a.w~ w~w ow~.w +os. o~ ty~p pi wSNESS O~ ~?+OUStw ~ ott~s W .ouwe iue. .r nn~es ~ ~ 2G4-42-3584 COLONCL [J,S. MARINF. CORI'S ![SWENCE-St~?t tOU?+lr C~tr. t0~+. Of lOCstWa ^~spe c~^ ~~.~is St~tlt iwC ~+uM~Et ~ ' ~a~~ ~v~a.. .i~ w .a. . ~w E~LOIiIUA PA[!~i B[iACfl PALPI BI'ACII GARUi:NS YI:S 5580 TM1[iI:Rl.l1NE (:IRCLE ?~InE~-NUn[ .u~~ .roa~ ~.s. MOTNE~-MAIOIH H~MI nO~ .~oae ~.s~ . 1 , „ GEURGIi G. lUU1NfiR SAl)IEi LOVING ~ N+ww~wt-"~~wE ?uKwG ~oO~ttss ~s~.~n o. o..o . a~. w•c.», +,•n. ib~ 33a 10 ~ P~RS. RU7'!! IUUINI:R ,,.5530 ~TAPiBERI.ANF CIRCLF.,PALN1 f3EACil GARUT:~S,fLA. ...b.... i ! ~.n. w.} ra~~~tif ItNiE~ O~Mr O?~E C~USE ~E~ lr+E tOR bL AL ~~+D (41 ~~~r~ew oMw~ •w w.n~ j , 1~ r~MN~a ' H ' ' ~ f~ . v ~ ~ /U a ' - • a~ COM~It1OM1, ~M~, • . rM~CM G~+f ~11~ tp ~ Irrl~~~~~ C~VS! /0/. ~ ~~Mya»Kf a: fl~~IMO ~M~ VN~~F ~ ~tIMO (~Yl~ I~S~ - - • - - } 1AtT M O~H[~ S~Gr+MK~r+t CO?~D1I~p+S~ cw~ano»i co...Mw~.w w w.w. ~w .a~ nune ~o c.u~~ ~.n.. n. ~ w~ w11TO~i~ ~f rES ~tMO~NG~ CO`~ j r qs p~ .q~ YW~f~ ~w O~q~Wr~MO UV1~ ~ 1~ h0 N ...rr - p.wM! 1 ACUOlNt, yp1(~p( Qf bA~~ 1 ~ rp~M. O~t, ~~~f ~ f1011t NQW (N1UR~ OCCVtlfD ~ IM~~~ M~IYM W ~MN~1 ~M ?~1~ ~ p~ ~~N n, rt~r 1 ~ a Ot HPOtfIWWlO . ~ _ ~ lw M 7M ~ ~ fNAJ~~ Ai WO~R ?I~CE Of NIU~~ Mor. ~ur. fnen, rae+p~, IOCAOON ~ fn~~~ W~. r•..o . tm o~ rO•~w. sn4 ~ ~ inc.n ns w..o ~ a~~a Noc . nc ~ snarr ~ 16 1M „1 CE~1pKwi~ON- +w~r e.. ~o~.w. s.. ~.o i.~~ s.v .~.~w~~ a~,.~ o.. . s.o/ar~+r rNr /M OtAfM OCCVNED ...t ?uc~. o» ~w ?NrSKun~ ~f 1O ra.rw o.. nu ~w. .~n~ a.w. . ~..ov.~ o..~. •..e. ro.a a•. ~ ~n~weis r.~ ~ ~JO ~ ? d w i~.o~uow. o.• . ~ 1~~ ac~.?ie iw. V _ ~tD H~ ~ n~8 :458 M ro ~w~ c+~sr~s~ suac wv~ a w.n. •w~ eecioe.. ~~t .~a+ou~.c~o o~.o ~ ' CERI1IKAilOl/-w~[DKAL E~wM~?~Ef Ot ~OlONE~ o.. rrt ~.~~s p~ ~ ~~~~M~~IOI~ W ~M~ ~00~ ~MC/O~ ~M M~V~StR~114M, IM Y~ Q~M~Q~~. rM~IM O 1~~ M~y 4 Of~w~ OCCWNO O~+ ~Mt O~~/ ••a oue a n.e t.uun~ ~nno g - A 1H M ~ J , ~ ~ '~LL"' } CE~~Ii1E/-N~{M! ~e~n o~ rewn ~ S~ ~ .~u e~ - OAiE SIGNED ' M: O~t_ f~~l1 f Lou i s ~o~u~k;_~__ h1 D . _ J~ - - - - 9-1 b- 77 ~ MAMN~G AOO~fSS-ClftNl(~ f,ni~ ~4 o ~ ~.n r... ~ sr•n r:• ~u 705 ~O. OI.IVE ENUE h'ES7' P1\IA1 IiEACtI I~I,ORIllr1 33407 I ~U~II~I. CKMATION. R(M1OVAl CEMElE~r W GetMAi~r-iva~wE iOf,?I~OH , c~.. e~ w~.. s•.~e ~ i tMtM r ~ ,M f3UR1AL IIILLCREST M[7~KIRIAL PARK hT:ST PAI.~! BI:ACH, FLORIDA f Ow/E ~ P.*~. Wt. a~~+ fUNERAt IIOM( - N~M( irt0 ~DOf/iS - s~~eer or ~ r n ~o . c.r. o~ tOMN_ S~~f1. L~ ii ,N ~-19-1977 ____1,,, NQK' IHOU11 (~UNERAI. 110~1E,5608 BROADI~'AY,h'EST PAI.I~i BCACt(,FLA.,33d0: f Y.S. #61Z nEC~o4 - Sr ~y ~EGiS~ew - SiGa~r o•q ~~tQ~~reo ~ec.i ~^~r.~sr~a~ !i N~Y. 7~78 IM 7N ~1 ~ ~ ~ ~ i ~ . - - . • . . . . . . . _ . ~ r . . K-. , ' _ _ T_ ~s ~ 1 f S'~~.~ . . . • I HEREBY CERTIFY TNE ABOVE E.A TRU$.AND CORRECT COPY OF THE REGISTRAR'S RECORD ON FILE IN TNIS OFFICE '"i , : (Not valid unless the sea~l~of th~~Palm Besch County Health Department is affixed) . . , , . _ , - , -':1 '9 ~ / ~ ~ :'r ~r' ' October 7, 1977 '1 c.L. Brumback, M.D. _ , Local Registrar ~ Bureau of Vital Statistics ! ~ West Palm Beach, Florida ~ ~ . s~~ ~ z~s : _ _ _ _ _ _ _ _ ~ ~ . _.r~ ...a~~