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HomeMy WebLinkAbout0842 1 V' ~ ~ CERTIFIED C0~'Y y.~'7~ ~iv~ ' V' ~ . {p. i NLRf.Or C[nTi?r ~NE ~Orv aE~~qn0ucE0 pEi_nw i~~ L~C ~ rR~,C ~r.0 CORpEC'i r.Ov+~ ~.r p i^~{. ~ ~ sA iHC Ot+~6iN~~ REC~RO ON fiLE ~N TME (7l.'NEAi~ pF ~iTAt. STAT5T1C4 p/ TME STA![ GI ,r~ ' C~' ?lOR~OA~ D~~ARTA{j~T~Of NEA~T~ AhD NEMA6iLi7ATly[ y~py1CE5 AT JA~KSOhYill[ ~e;~i~ , ~r, ~r ~p y~ c~ ~ RLORIOA , ~ ~ . ~ r,~ ~ ~h01 Y~110 UML~~~ iNul C~ /M~1~~f 0! ~LQ}Ip~ Dt~~I1/Y(~t if1`'~ r, V~ OI wf~LtM ~hD RlM~Hlit~~.,~ ~ w i,t~ (h r`,', ~t~neif .Rri~to ~ ~r ' 1 w t ~r y~1 ~ ~ . 11~ W ~c ~(,1~~ ~ ' , QNLV~ rQt~v . ~ 'ff ~uq q~.qrb~ ro~ r~r4 N~nlhn ' ~ ~ 1 f n r, ' ~ ' ' 'v~' `~M~''~.....••~,! * , w.~.in.~ . ` 0~ • ~~w ~~0 Nw~~ ~ •~~i~l +I ~ ~ p~ i ~ ~ , ~ , ~ ~,~:;ti~, ' G.:~ ~ . ~ " At,tENDEOJUh._:? :.~;6,,.. CERTlFICATE,OF DEATH ' ~~..w a iw.l~ ..r a~.Wwr„ f.~w~ t;~~+,~` ~ 1~'/R 0 R I D A ,~e rne ~o, . ~ ~ PAGE j~r ~ ~TAT~ ~OAIID 01 MIAI.TN AFFIDAVIT OF AMENDMENT TO DEATH RlCORO WdWp~~y ~N~~ • Mf ~~II'~ MO ~QI ~ ~UIILAU 0/ VITAL fTATHTICf F L 0 R! D A PAGE Z OF x+ o.n a~« i~W1~ N~~NNi 2 ~ Gre or - . 9 Y Iwn 8edni~k ~~le N~M~~ ' sr~rcr~u?a. ' 4d~++w,wao.WKu~,.w„~ A61~ 1 h2 Z~ ~ 6 OLGLA/[C wi v+N~ ~ w~n i r CW~R?p OIAM •u ~MC.,~~hi ~~~n.~~ .a»~ ~;;iau~n~~.o.~.. M,, ~,~KO~..~«T~ Grecory Iv~n Bedni~k ~ ' t~ ~ - w ~ ~ LEE ~ 0~T row~r o~r ~u• ~.~G~ 0~ OL~iN c~... ~n• e~ r,pc•tro~ ~ ~ ~ ~ ~NN fIN l~nl H COY~rI w<Ma~a~ ~ N ~e•nw~nw~,o~n~~~~o,~ Ot~TM FOft NYlra _hav 22 1976 ~ Fart M ers Yes H Fort M ers Comn,unit Hos ~t~l y1~11 ~M Y0~ ~M Y 1~., ~~q 1 y~,~l C~~~, Q, IT[M OMITTLO O~ IN L~~O~ D[~TM LLIITI/ICN i wV1it0 ~kNl ~uAM10. IMtitrN S! rw, ~M r~.+r ~ ~ ~MOW~ ~NOULD 1L ~ _Aussi~~ cown~' Caneda wroowlo ,r,cw~ . , ~yarrie~° . _ , _ sOCiukC~rvrN,~w1`~ uswt CY~etqi~~,~~n~w~a~a.ww~w~+o+a~a n i deg~rd Klein 264-1~-66t9 ~~~M,M+xy~~ K.~oaw~~eaawouim D~te of de~th w Fn ineer MaY Z~~ 1976 . M~y 22, ]976--- as~o~wa_~r~n Elettric Power CRf, TOwN~ 01 lOCA1~011 y4N fn~ irN1 j , ~ ~.Flnrida lee ~~..~~~a«o ~ape Coral _ - - ~ ~ ~•'~u~_„w Yes ~w334 s,E. 47th lcrrdte • YII MQ11QI..IIyIDfM N,~Y~ IM+~ . ' . ~ . ' G reoor - w~ _ ~ , , Y Bedniak _ _ . . _ _ _ _ ~~«ow~.,_~,«u ~ne~~'lari~ ~6 /ers~'e ' { ' ~ ~ ~u4n+G AOG1I55 ~~ro~~ a ~ w, tn~ a~o., I I Ni}d¢gard 8edniak _ , ~ ; ~~33~ S,E. 4]th Terrace, ~ape Corai, flori da 3390y 6«~.~, ,~,r ` ~ IN(O~MAMT { y~4NA1U~~ ADOR(sf a~TM w.s uuuo n N w ~QI Iq, fll. ~NO Id w. , t~' <(W '/L{ C u~~~,o~,~owc,~?n<< ~ '.c r.~t /''~~!,:,,,~ci,~: ~ 33 S.E, 47th Terr. C 3390 ~ 'I \ ~Mtill~ O~Nlti+li ~N~ {~MC~~~[0 ~ti0 iMO~h TC /t~0~1 Mt OM T ~ . ape ~ora1 ~ .I G~~•MMI 01 NC•1~~ b1 „~,11 , ~ ~ ~ j "N~t5+y4.+„r~r!S~~Of4~rdlAtLN~! ~ ~ ! ~ ~ ~ I Hay-Z+ ~ ~..1!/.rC ~,~t~ j Mr t~m,~~~.~ E,~~~rsluh~~.1919 te.~nm.~ n ~ ~ ' ?uet'J~~ D~~t['~~ 1 i~f~~ru~R ~ ~ ~oG~ru ir u~ +~~y,~'~ 4~N ~~N ~0 ~1~ 1 ~ y . . ..i`~.'i:'ru n~, ~ I~ ~ I~ , U l n I Laoe Cor~.i Fli.3 704 11 ~11 VII 1~~ ~11 ~ ~YI 1 ~ 4w ( p ~L ~.w ^'^'S ~ 3740 Prado Btvd n Iq ~ , . i ~to .ro {MO~« ~o ~crQ~t w,t o, ` r c. .o•.~. j AIG~~1Y ~~wii..~Ft?:~~{L~Q~ ~Ii~ . ' r~lr u~ atW~ SKi~+xK~ ( pR~ ~ cwww 1~1 ~t ~ n t. ~ ' M~ 2 6 %Y'i.f/~-t~C~~. ~ ~ u~ ~ 1ury L 29J9 ~0 ~O N~M IYI M0~ UWIC 10 qYN O~qw iM 1N1 i NI M~~7 N 7 M Y! MMH~ In~y1~~ F. ~ ,I ' C}7{ ~ ~ ~ IS .~n r~.e~.o~ w, ~ .rr~rc.v t: ~c• •r rr.ow ~ .i~e 'A ~ a.o~ a~i:: M4~n~~p 4WI r. i,.r:. XS:~"~ _ . + - . io.~..di, w von~ ~ ~ ' ~.a~. r~,.un NO , ~ ~ ~~~~1 ~ MOW INlU~1 OCCUNIIO ~~~m~ tiiue a iw~un i. r~n ~ p r~ m~ ~ ~t{rR~CT G~ IurrpR'~tiG LviOt~tt 1U 0~'~~'^~ ~ * Y 1M A~Y[ ~YO Mi~O 01 OOCNM(~f 4 ! Nl~welq 0~ ~ ~uCl MlNr.r.w,~.~..~n~n.~.oon tODU ~ lluOiAd ~r wwC~ yWl~ ~~D W•C C~ ~?Rf ~ 0~{y~. COC~+1~• a~~~w..,~ ~M~ o~ ,,~~„a~,.~o.~,~a,,..,~~.~; ~ Affidaait b I M~1 Ya•( ~n,c~~~, Y , en e ,.D , e ore not , ~C, u e 91f / ' ~MINdw ee~ Z ltner M b f ary rubl' J n 10 1 Ihr1~(I~M / N~ ~IN ~ ~WM Y~ fl~l . ~wE Y1~ Y~ M'MI~ ~ ~ ~.ei,~rr~.r ~ ' w,,,a "~u' . . ~ ~O ~ OW; 14 ~01 nl~ lYl .I~tM O~{VIND M`V(1. 6~ Y~ ~ ,i ol<~.f~t ~ nw Ilw~ ~ ~ e.•. . D/L M M4~ . ,1 /yY, ~711~~~( / iL . ,;i . i • ~rvqppi ~ IA~p11MAT10N CCNCC~NING RLGIi'RA4T ~ . . v ; n'U,e1~f WL{„IIAMINII `CMON~1 0~ rq UMO~.~•~'J Y IIn3 7J ~,e; H~~iE i { iT~T~D Ih DOCUMLNT Of CO~~L{~OAC~NG 4Lr~IR ~~.1~Z w ~G W N W~ C~01 Iq wql~rtw~W~ rM ~ ~4YI 0~ . 1.. . ~ . ~~~oc<w«co.+~N~..e~,nro~xo.wn,n.n~p•~a a.iv ior~i.~~.ro.a.nou`n`o~~ ' QP~ ~e ner states th • " ;~M N~ w.~ e ate of 1•1av 14 ~~ras mistakenlv tvned in insiead of the ',I'''y~~l~«~~ m ~ ~~~M ;cs,therdoc opMte af a t6 by the °unernl home and this date was not nated bv ~ NtNf p„~ -r:~ ~s~~.~./,.>;» o.. ~ a~hen he ys f on ~ 91 . ss_<~„~„~, ~ ' ~n ~ ~n : , , d he death certi fi cat ' ~M~~ar~4 r . _ 1^. e. ~ ~ f Ir 1, ~ ~ ~~{M/~11~,11M~IYAI '~~M~7~11' / ' .a •~~n~ C~IM~i(11~~h~41 ~ 10Ci~ 4~ t~Qfl ~ c,•a~o„ ~yy ~ ' ~e.•e: .-nip~, , ~ . Fort N er c:., ~r..rs v, . s•,~ , ~Y_ w y ,o,~ ~wu. N csai r„^atory Fort M orida ' , ~iL~~ y~ ~ ti~~ i.~: C~r~.i: M; t o«~- _ ..._ei~, !..-~^.l--- ..o., . ~ . .Zi!?'~Y, Q ti~rl ~ND ~ • o.r i.r E~ 0 25~ t 6 ~w Tant Fun r f ' ~7 I wan.~r,us ' !~5 6 ~ M~~~~ p~yGw~yi • ' .ht 4~ ~C ~ a A t CO f a F 1 i~ 04 • Y.. zr-.w.:-+:+::.: ~'S ~ S~(.N~I 1 C . , ~4 ~ tilti , ; Gy,~ ;r.~. i 4r~, ~ ~ . ~ Dsq ICI~~IG Ir i 114 f•~M • ~ ~ . " . ~ . ~ ~'^,1•n w~ ~ ~ / . ~ ~ . ~ , W.~4*~-i-~'` ~1(r~ ~ y'i . . . . _ ~ , , • . , . . . , ' • ~ ~ ,~.,r,~. , t.~ ..w. ,y,w~~, . . , ~