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HomeMy WebLinkAbout0051 '~'~fl31d Ite: Lot 16, L31ock 1, AMY ANP~A I~AE2K, ~zs f~er ~l~it thereof on Fi lc.~ in Pl~t t3ook 4, NacJe 72 0£ tt~e Publ ic Recorcls of St. Lucie County, F'lorida. ~~,~1~, . STATE OF OREGON - HEAITH DVISION ~ - ~ v~ Viui S1~tistics S~ctian ~ ~,,,;,.N,,,,,e„ ~ •;ERTlFICATE OF' DEATH ~ ~ SuN FtM Nwnbn OECEAfEO-NAME fir~~ IN~dd4 ' tat DATi OF OEATN (nwnM. d~r. 1r~M) Robert Harr Riker ~.Se tember 19, 1975 RAC! \YA~M. Npro. An»riue~ Ind~n, fEX AG -l~sl UniMr 1 ~te. (~p~e~h1 buMdw (rw~I ~ UndN 1 d~y OAit Oi ~IRfil (enoNh. d+Y. Y~1 mo~. d+r~ hows ~nin. whi te mal e s.. 65 s~. s~. a October 26, 1909 EASED CWNfT OF 0.°l1 CI . TOWM, OR l t10N O/ DEIITM n~id~r 'ty limifa NOSIITA~ OR OTNER INSTRIITION-NAM! (~p~ei~Y ra a eel (if nW in ~iM~. oiv~ slna ~nd ewmbKp Lane Eu ene es ,d cred Heart Hos ital ..,.,k^ce STAiE Oi ~ItTM CIi1ZEN Oi VIHIAt CWNTt9' MARRIE0. Ni1/E! MARRIE0. NAME OF f/OYSE ~~:e ~sed O! nW in U.S.A.. n~ oountrY) wioowEb. DIYORCED (+weih) << e. Flor'fdd v. USA ~a married S lvia E. Riker SOt1Al SECURITY NWM~t! YfWI OCCWATION (yiv~ kind o dw» durY,p KIND OF WSINEfi Ot (NDUfTRr ~~~Nfore ewu e/ ~ih, ~v~n if nr;nd) ~2. 574-01-9419 Suild n Contra~tor „b. Housin RESIOENtE-fTAiE COUNir CITY. T . OR IOCATION Insid~ Cih limit~ fiREET AND NIIMaER O! l.f.0. z... Ore on Lane ,k. Eu ene es 40 West 23rd FAfMER-NAME tka ~aa~. ~on~u-iw:e.~ r~.~. h.u ~~de~. +..r ~NFOw~u+r-N~ .~a ..ar:o~.ti~n a dw...a 15- - - S lvia E. Riker wife .pp.o:~m.u ina.vd YART 1. OEAiM WAS CAUSEO tr~ (ENTER Ot~IY ONE GWSE PER LtNE FOR (b~ ~d Icl) b~twNn onaH ~nd d~aN~ t a. n ~ ~ ~ 0 3'-/s d~. w. « .i . we..w.ne. ar: Ca+ditipns, if ~ny, . whid~ y~w ~i» b (p) i tJ S E i.w~rdiaw ~auae (~b dw ro, or a oona~qu~no~ ole st~tiny tM u~ber- lyinp cau» Ipt kl '?ARi ii. Tii~[ 3iri~~Fi~~'fi z iiiii~.:$t ~:ia.-~s oo.=+A:`c~-tu~ 'ss a~.n ~4~~.'-',. s:~ !a Pyt !(e! !RlRQ?SY li Y~S wa~ findings oon+id~red ,y., f~. ~ ilr~+ o. ..oY del..in:..v~q cw..~ oi ~ie~+i. r w.. n0 we. Att DENT DATE Of Ji~RY N011R IipyV INJIl~T OCCYfRED (enN~ n~h~e of injury in part 1 p pnf 11, iarw le) I~ac~fY Y+s w nol lnwnM~. day. rMr) - - 20+- ~Ob- 20e. AI. 'Od. IWYRT AT MI0~1( rLACE Oi tWllRY N t+ati, anw. stn~t. ~e~oeY. IOCATION (and ar R.F.D. No.. ei~y or bwn, e~ounty. st~n) (sv~h Y~s a no) offioe bldp., ~~c. (+w~~h) ?Qe• ~p{• GERTIFICAiION- nwntb dsy y~ar ' And l~st S~w Hi~n/Ht~ Aliv~ 1' pid Nof OiAiN OCCYRRfO ~t tiK Plap. pn tM PHYSfC1AN: l~a? ~ewnN~ an: nwMh d+r 1K+r ~itw (?~ow) daN. +ed. b tAe t anended t1K ~fNr deaM (~wc+hl b~st of my know4 dec~awd /ran: a ~ ~,t~ - '7~ T z~. , c! - /S - 7a ~ r/ - ! ~ - 7S 11:33 a,M. ~,a~»~ IMrfl[ - i' AME (hP~ or w:m) d~9ns a Titl~ OAiE SIGNE~ (nwnth, aY. r~+~1 TIFIER ~ ~ n.. r~. Herbert C. Baker M. D. MAt SS-~NY ureet dM w lown ~ asq :ip 495 Oakwa Road Eu ene Ore on 97401 6URIAL, GiEMAi1pN, tilY{OYAL, CEMEiERr OR CREMATOtY-~HAME LOCATION cih p town su~~ DAtE (ma, day, yM~) MAUS. Itpetifll ~iAt burial 2.~_ Lane Memorial z~. Eu ene Ore on z.~. 9/22/75 fUNHGI O ECTCR-SIGNATURE f11NERAl NOME-NAME AHD ADDRESS (strMt, ciy a town, stst~, ~p) n,. ~ ~~!~-c,~ Chapei of Memories, 3745 W, llth, Euqene, Ore. 97402 REGIfTitAR~1~NATURE ~ DAiE REC.EIVtD ~Y tOCAI RHilSTRAR DATE R IVED ~Y STATE REGISTRAR ~ i :a ~ - ~ `L ~ r f 3 ~ efscev[c wae ~~s~wrs u - r~. - VS2 R-0~Y c-f~ : - . r• - a.t t . . , ~ ! . . ' STATE OF OREGON ~ . - C~:nty ot Mul~omah ~'s. ~ ' DA?E 'iSS~~ ' 15 ~1~75 : ; ~ - ~ : ' C; I he:eby cert3Ey thst tke focegoing eopy has berq`~om~rued 6y me ae'i~tba osiginal dxmaeat ~ aed is a t:ue, full and ea-ect copy o[ t~ie aig~~ ercificate a~ ~{~si~san~i appsars oa ts~ in thr Y~cal Scacsrics s~~~c8~~ o-~gon Sts.z~~ ?h Divi={oa ~aa~~:st~y ofEicial c.ire aad cw-taly. 'r;IEURM~ flA. ~dF;^~..d;~ s`; sq. ~O IErCOO 1RA` . , r ' ' ^i 420310 _ ~r,K ~:;~C~1~ • . ~ ~ .c1t ~:-f.~ ~~it , . - • - • ' ~ . . ~ . . ~~T'6 IO 44 ~IM 1't - , ~ ~ ~ P~.I.~TP AR . . ; . t~ . - . NEILL ORIF~IN JEPFRIES L LLOYD t` ~ z t H~,t . t' ~ - ~ . l~~.. . ~ ~ ~.1:• :'IF ti' ! . F ~ a . 'E lt ~ ..~~1 . . .s.o . ~ k txF°.x _ . ' Tv ~t +.x ~ k~.a. - ~ w__ . y . . ~ . . ~ .~ttn`°~=F.'`~'ait„t~