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HomeMy WebLinkAbout0538 CERTIFICATE OF OEATH ~ ~ De~ae1~1 J Ile~ld awd Rel~ab~lii~~l~e Cetvice~ ~TATi FILt NO. a~~nx,w ?~..nu F L O A I D A irvE. O~ •NNt IN ~'~~~'a~~'~° ~ 1~t01iT11A1~•i NO. ~~lMANlMT INK ~~EwSEO-~+~[ ~~~u +'~u ~~t~ DAIt Oi OEAM ~ rortw, o~~, n~~ ~ SiE ML101001 i01 ¦snu~a.s , Al~a Catherine Rillian ?~ve?lio ~r'e~ale ~ October 1 1 •ACE ~•w~n. Mww. .wtic..~ N.wM. wGl-?.u w.a~ ~.e.~ ~ o.. O~TE OF HtM ~.a.m, w.. C01M~flf Of OEwtN ~ 1 rr ~ M~~wrt ~ tt~~N r0l. Mq MOY~L r~a. ~W ~ ;`{,ih'~~e . d3 ~::-~r 2 19~7 ~roir~rd IIY. iOwN. O~ IOCwT~ON OEA1M ws~ un ~rm MOShTA? O! OtME! NSTRUT - ~N ¦o~ ~~~w~, cM s~r~~ .w .uwe~ ~ /O wcM. .~s w .a ' ,~:iollywood tes iiemori~l cios~ital St~TE Of WiH ~ n wo~ r~ v f~, wu~ GTIZEN d MMAf COI1NTt~ MA~~IEO. NEVER MARbEO. SURVIVlK' S~OIISE rN~. 6M r?oer ww~ ~ ~,~.,a..~«.~. ~,::e:r Yor'_~c ~~.m~ ~ U. S. A. N°°•'~c~o:•o~o~~~., - .»~n acweo SOCuI SEGURIiY MJWE! USUwI OCCL?~iq~ ~ aa a..e o~ .wa oa.~ ow~.w ros~ a KNdD Oi WSR~ESS O~ N+DUSTRt i~~to r «an~ ~I~MO lM~. ~Y~N 11 Hh~t01 o~~ „1 l:i-1 ~ -5040 ..ousej•~i f e Own Home 'fYDtwC~ NtOM o«u+o-' lEStOE?~CE-StwtE COUNTr CIT1f. TOWN. OR IOCwT10?~ ~Mw cm ~rm STRfEi ~WC R ~ 1f1~(Ml /!1 a M~ ,~'loridz ,a~ro~aard :olly:•~ooci Yes ,..1329 :~oose:•ett ~tr°°: fATNEt-NwMt n~f~ r~pa~ Wt MOiNER-W?IOENNA~uE r.et~ r~oae ust ~s Jorsn 3. Sc:eene.y Odette C=-:~~tellier 1?~IORM~ANT-wah~E . ~u4wG AJD~ESS ~ snti~ u~ r o.w . un w~o~», s~.re. tr~ O!~'] ~ J ~;~:rs. .Far::areutte sluttin:- 13 Gluttir.T Place. ::anover, i~Tp~'7 Jer~~v ' ~i~ u.~ .~i ~ART ~ pE~TM wwS CwuSED ~r (ENiEf Or4~ O?rE UUSi ~[f lWE iOf lo/. Ib). ~~+0 ~Qj ~er..u.. o»sn •..o oe•u t1 ,.ra.n u~a~ - ~ 7 / ~ C V ~ ~C ) ~ r ~ i~ h' r r ~f J ~i rti,~ 1 J ~'I ~ ~ r ri ~ 6Gi~3f~~ii~ii~Z r t COMO~tiJw~. ~w~. ` I ~ IL ~~.~~~f~~ Jy1 Lrh.~ L ^ rr~Cw a•.e •~u to (e! ~rrlD~~rl. :~uif ~.e~. Du~ ~O. M 1 ~ COti1~OWK1 Or . " u.r~»e ~~ae.- / ~ Z!./_ u~..c c•ute t.s~ t ~ p ~~•~a. ~cl - ` `R- " vt-~. , l. Lvt N ~ART p OitiER S~G Kwtrt COr+0~t~5~~ ~~~~a+s co.nn~un..e a w.r» ~e. »o~ ~w w c.u e~+e+ r.n ~~m AUTOIS~ K~'f5 ~l~e r~tio~.+~f co~~ 7/ ~.~s p~ .q~ Es~oe~eo ~r o~n~.~«~..o c.~u G~ ti ~ . ~ ~ ` C...E~tiV• ~ . tw :i0 I w ot.rM (hep~oW~ ! ACCIOENT, SU7CYp[ Q~ OA~ iN1U ~ rO./tw. o.~. ~e•~ ~ i10UR NOW INR1Rt OCCURlEO ~ Wq~ •urutl Or INlV~~ ~w r~~~ ~ o~ r~~r a~r ~ IqMIGDE-, Of UNDfTEU11Nt7 ~~h~ ~ . . - lOt M !0/ IHJURT Ai WORK 1lwCf OF wlU~r .o.e, srKer, ..aw., ~p~~ii0e~ ~ suen o~ ~.~.o. ..o , or. o~ rowN, sr.n ~ 1 NK~A tli O~ No i OMK! MOG ,!K ~ YK~n ~ ~ ~ ~ CERT~fKwT~O?~- .a.T» a•~ n.~ t ..o«e. o., •.w u~se s.. .rr~e~ .u.~ o.. . aoio~a w~ .,e• r.u o[~rN otcu~no m~ n.:.e a.- -..f ~Mt31C1I.N: . rOMM 0~~ ~l~l ;~00~ MIl1 Of~M iwtlV~a D~tl. ~rD. TO'~f ~!S' p1 ~r lrqw.lOC!'. J'~.! t ~T11r~OtD fw~ tO ~ o~«..~o,.~_ ; ~2 19^~ ~~~.vc~ 32 197~~~ ~10 9 197 9:18.;M ~o.~.~.,k..,,..~~o CERTIFIUTION--MEO~CA~ EaAhUNER QR COROI:ER o.. r.e s•vs o. rw ,.pu~ or oe.rw ~ r~~ o~eea..+ .~s ?w..d,•.cw oe•o e~...u..rw~. a :~i r~c. ...o, o~ ~~e ,...~e+...•~e.. » er».:o.., ..o»rw o.r .e.~ ..ou~ Of~~w OCCY~~lO O~+ Mf G~~! u~D Ou! q'w! CwuSl~fi )i~~fD m ~ M ~ ~(-~-~1 _ 1°70 1$ k.~ CE~TIf1ER-NAMf nrf o~ ?~n.n • AN ` oeane q rau ~ UATE SIGNE ~ r» o../~ nu t1~ 7 _ ~:t ~ ~ 7J~ ~i v l'`• ~ tk 11 2 ? ~j ~ ~1 ' _~:br.~--- ' w~RwG Q 55- t4nr q s ~n~er o~ ¦ r o»o un o~a.... si.r~ ~(l ,~~1 4:0~ ~~r+:ood 31vd. Holl}^~coti Florida 3:~~1 ~ ~ln~wt. CREtitwT~Ori. RfrtOvwl GEMETElt OR ~RE!NATORt-NAMf tOCwT1pN a'• o~ ro..~ sr.a f ~ srt~,{n . _ , _ . I,~ 1N ~ 2~~.a~.~~ • r n (J: rr:~°y:~ N~ _ 1 1 y n ~:z ial i 1 v::oo~ =1~.:1{• OAiE ;ro..*r. w!, ~e~~~ fUNE~AI NOME-NAMf AND ADD~ESS < snett O~ ~.r o. ~.O , Gnr O~ to.r., si~tt, t~~ ~ - •~Qc~ t nf_~,- 1M ~'t.. ~ ~ ~i l 7 ~_^~vG_n •~~rc~~ ^7 , ~~i'~ ..c` ~nr.:~ 1 - i i. ip fUN uE G; r rE REG~~ j R-S~Grraru?f ' _ - / ro•~[ . ~eo ~r.iotwi ~J[o~nu/~ ~ a e 19 T 0 . i GC~~ ~~i'if ~v_~,J' K 6~/ JC%Cf~Y 4~. C~O~l.~ .1 V' $ = - 8 ~ CERTIFIED CGrY . ~ FfLkO RMG RECpRDE~ - ~ St. WCtE COUN?Y FLA. I hereby certify the above to be a true and correct copy of the Local RoCi a~~tTRAS ~ ~ CtFfK ;.!qCUiT COURT ~ Registrar's record on file in the Broward Count~ Health Departc?ent a~; ,r::;~cEO_.,.~_ ~ Fort Lauderdale, Flori3a. ~ ~#T ' Oct i l 3 oi PH'T8 ~ (W~h~~':'~i~ot v lid unless raised seal of the Browar3 County Health ~ f ~ i~;, "Ixepar~ent is affixed. ) 4 ~ ~ ~ ~tta~:- , r,~ . ~ • I• . % • ~ ~ ~ + ~ ~ - s.. _rF , ~ _ c~' `f ~ . t' ~ ~ ' _ ~ ' ~ - i ~ ' ~ t ? . . County Health Officer and Local Registrar ~ ~ , ~ ~ % ~ ~ ~a:~Z~~J ~ r ~~~2~~6 ~~E 538 • ~ ~ ~ Deputy ocal Registras ~ . - . ` ~ m ~ ~ i . ~ . , ~ ~ ('~l ~ , x, . . _ - - - - - ~ ~ xz , ~ ac .~~,;z ' j; ~ ,r~~ ~ A . z~~ ~ ~ . , . . , .~r~ ~'~,1~