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HomeMy WebLinkAbout0227 , , i 8 1~ ~ ~ ~ ` . / i CERTi~ 1 Tt OF DEATH I ~4~..dw.~~d ~1 an~ I:~tiel.~id.t~.r. ' STATE i11E l:O. '".•.~,.."!'k."" FLOP.IDA NEGibiNAR'S NO -'.lfh' INi( O2Ct~1lO~wt~~ ~ ~wa.~ ~.s~ Owl: W DE~te~ • • i_it f~! + Sta +ur.+, .r,• ~ Jiess k'i112rd }:od~es I~iale , I~larch 1? , 1 8 ~ twCt ...~e, «~a.a..~~..~.. .+o.... aGE-~.s. wa• ~.e.. .w~. Cwt! Oi ~:~tN ~~o»•., w., COUM~ Of OewtN ~~c . wcw ~ 1 •,..,a. . a.•s~ w~ ~..s w'r sa. . . l~'nl ~e ! S~ " . ~-21--1919 ~Union CRY, IOWN, Ot IOCAI'~pi Qf ~.1N wt~ c~n ~r.q MpS. w~ W OTMEZ NSIIfN~-Hi?M[ ~4t ~u ~~~N~. G~ ~~N~ w~ wrrn • Lake 3ut1 ~ r ~ , w ~ No Rt . 1 3ox 664 S~ATE Oi WM ~r n~• ~r r s~ i~•~•~ Cii1Zf++ Of w~6~T COtXtttll ~.y?t1tEQ, NEHtt MA~atll, SUlYIV!!~s SfOUSE ~r ~a~, r,~~ wy~r ~w.~ ~ ea~•••~ O.O~+~OtCEQ veer.~ ; ~ Florid ; . U. S. A. ~'i~~orced c r..» SOCe~? StCYtliY Ml~+SSt USU~I OCCU?~I~ON ~u.~ a..~ o~ .~wa w.~ aw~.e •os~ a tu+0 Of WSwtSS OR trILVST1t rWa..O ~ur, P~.~ w qw~M ~ 262-22-4406 Road Grader Operatar Union County RES~OlNCE-St~l( COtMII Ctill. T~w ....es~.wH w•w~ c.n w.n sT~e`er~u+p NUY~~f ' „ a .o i Box 664 ~y Florid~ nion 14I,ake Butler ?~o R~. /ATM:f-NAMf ~nfl r~OM! Y.st MO:M=1~/Mt:DfN N4ME ~~~Y wMp! ~,y~ ' „ Aar n Hodger Ollie Crews ~n~Ot?+~wt-nr~wE zv?KWG w9GRESS ~s~nn o~ ~.~i. ..o, t~h W lOrr, a..n. i+~ hirs. Ollie oddes Rt. 1 Box 361 Lake Butler. Fla. 32054 fwRi 1. Dtwip Ww5 ~'J?UStO ~1/: [ENtEt r o++E Gusf ?ts t~+E ~O+t (•1 ISL wr+o /cq ~w u.r~ ~ •~TrfM 0~1~/ ~y Ol~1 I~_ ~ M.lWR C~~rM . ~ ~ ~ . ~ ~ ~ wff i . (OMNt10Mf, M ar~~ • ~ ~rwKr p~t! ~~f~ t0 nl~ ~~rlN~1~ <~Yft 1~~. « w1 A COrk(N~ Cf M ~t~1~Np ~w~ YYO~~ ~ lnr0 C~Yf~ USl - twll OTtK_R SK.?+wK~Wt C ~S: caw~*dn co-wwvw.o w a.n. ..oi nuu~ so cwu c..~« r...s~ ~ a. nV?O?t1 V tES vu~ i~,.~.,.ss caw ~ ~ ~ ~ ~ ~ ~~~f W +W~ fN~~e~ ~w ~~~f~w~w~ t~Yf~ : N~ O~ ~~~1w o~.. i.~e~~-"` ns~~rwe w; w r ' ~w ~ ie•~, wOW IN1U~~ OCCURiED M•nn o~ ~rw~~ r.~~ • ~K~ • Ot WD~7[4.w10 ' I w~.a N, aer u~ ' ~ 7M M !~I . INJURY AT WWR fU?C[ M~tll/~T.~ wor. ~.a., s•n~ : i.ewe~. lOCA110M ~ iven o~ a~_s_ No.. tm o~ ~o ,».M ~ ~t?tC~n7~fO~+Ot ONKf .~~K. ~fMC~1'I~ - 1 ~o. ~a x~ ~ CEtfffKAT~OM- .cwrw ~ e.• ~e•a wo+e. ~.r ~w ~+s us~ a~+ w~../.w~ ~un a+ ~ oe/ew w~ ~w r..e o~~tw Ottu»t0 a.~ iu[~. w w~ ?Mi3K~aN: riO~.lw O+t 7~~a ~Oes ~rit~ Of w 10 ~•w~ ~ Ma, ~w, w ~ru ~~Rfwf~O ~~1 p r~ 1~0~'alOG Wif 11• ?u~•s~o r~o. ]il ~ta . ~ 74. M io s.~ 4w»w si.~» CE~t1F1Ut~Ow-?ts~C~l ti f O~ COZONER: o+ u~t ~~tq M~~q .w~ d a.w o~eeo~.n ...s+.a:....u~~ew ~~...wro+ O' ?e N~• ..o/O~ • ~•.•u~~e•ro«. w o..ro-.. .o~+*¦ w7 ~ .e.~ y~~ ~ 1 . D~~tr OCCVMM W N~~t~ ~wY O W:M C~vH~f1 f~~tf0_ . ~ ~_3`--~5[:5=~ ~ M !A CERbhE~-I~t/w[ mn a~ ?w.a ~ S~G?aA f wc. ~ won.~ OATE S• O~.orn.. o.., n.a~ 7)~ MP~ .r{~ Tl? ~ . ' Jk M.K~ ~~xss _~_~r„~=. o..... . o, . - 'J - S- 78 ~u SO1 S. W. Seconc~ Avenue Gai~esvi~~le, r'lorida ; 326~1` avLAl. UE~b~Trflx_ %feiDY~?l EMffEtl OtCRE+U110R1_!~~~uE ~ IOC~iI(.Ma a~o. ~o~~ sr.n ' ~ ar~4n ~ Buria? Mt. Zion Cemeter Lake Butler, Florida ~ O~Tf iM~+. 1? fUNERA~ HOME--N~ME ~NJ ApptFS3 ~ 3~~~!' O~ e.q.. O~ ~0... 1.•q l~ ~ Q ,~t?iar. 22 ~ 1 ,;~9rcher .~neral Har,~e , ~5 ~9. ~ake Ave .',Lake Butler, - . s~ 1.' ! ~ Al 6i3/~i fl7-SIGN~~' .~2• , t SK.Nt'{IR WTt ~lCf~vfD l0[~~ ~tG1ftl~ . . _ 7sf ` oc L • ~c~r.~• ~ / r S ~r 7J 1 ~ I hereby ce:t;~y that this ia a true an3 co ect copy o£ the death c~rtiFicatia - on the above naTsd deceas~d. The Orig;nal fi been filed by me ~ai.th,~ the Florida `:tate Board a_° Health. ~ ' ' ~ , - Si /i-e i Y.ary . Whitehead- Suba~egistrar I U.~vE r:o s~.. . ~ . : ; j s ~ ; I . , ~ ' ~ ~ ~ ' 1 ' . ~ . b. ~ ~ ~ ~ _ , _ - - , ~ . . . ; R.~ f