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HomeMy WebLinkAbout0072 ~ 4~~3 ~ ~ IN RE: VIVIAN C. ELD~R~ deceased ~ Lots 11 Blk 1300 Port St Lucie Sec. 12 and Lot 10 Blk . 1300 Port St Lucie Sec . 12 Attomsr m 1,aw ' St Lucie County, Fla. . Z131 Hollywood BoW~~~d ~ P. O. Box HH t 8ollywood, ~'!w 3~p~ ; . ~ i ('l:RT11~ICATE OF DCATfI S~atc Fi~e Nti ~ ~ri~rF I)R PRI ~TI - - - - ~ ~ it~RTN NO. custod~~n's No. • . N[ih~ O (~rft) IM~dtlla) (ust) 2. UAtE ~nnoothj (tiay? jve.r) l~l CEASEO OF , _ r 1 oEA~„ . ~ ~ ~i.A~ O~EATH(CountY) . ~.USUAt.RESIpENCEIl:~c•a,xcexcd..vad.Il~n1t~~~i,o~iics.uncaw7o~is''m~~ian) r• ~ ~ i . O . , t c.~:r or Town In C~.Y L~m~is Lenqtn of staY State `~_,Co„~~~v . a ~n~TT:~~ii~T Lenal7~ o~sTav ~~es ?n~o tn~s o~acel ~Ye: ? rvo ~1,~ tn~s P~a~e~ j.,~ s - c~~ro. r: ~.,1 i ~ ^ ~ _ ' _ - , li ) _ - - rTOwn ~ - - - ^~~~~ie o7--HOSO• o~ InstduUOn Lenyth ol stsy SUeet Add~ess or R.F.O. ana Box No. •1 0-.. ; ? 7'?~ .!a. ~ 5E x 6.1iAC 7. BIRT?1PLACE S: ca..~a?~ Cdire~ o what 1S. IS RES~DENCE ON Ifr.• pate ~ ~ ~ • counlry~ FAHM• REMOVAI • ~ .a a r~'Q""i ^ ~ . . _ ?ves ~tSo CREMA710N 3 UA (in year under 1 yea~ 1 urW~~ 2 Hrs. me o,emetery ocat on ( dY w own) (~ounty~~~taiel^ M r' 1 ~DSI Dirthday) Months Days Hou~S MinS. . . . - ki~n:-:~t•i n-.• , ~ • _ ~ - 7. MHA . . ER S~JA/:!E- - _ " - - r-L~.cnle N~~inGE~r- : h11~RHlED.Jty~ VEH MARRIEO If tnJ~r.Ca M 1k~dowttl O~ Sepatited, it~UWEO LJDIVORCED 9~re name o~ spoux. ~r~ ~ , nSEPARATFO ~ ~ " " _ _ _ ~.a _ •_..._c~ _ ,r.'_ 1 . . +.i. (}CCU~'AT IUN (G~ve k~•iJ of wc,~k ~K~nO of ~ui~ness O~ 1nauStry `{4~ 8 Al NO - . . _ v dw~nq mOSI 01 wo~kinq I~fe, eren rttuttl) ' 7~ ^ i r j J.~ r t n•,, i - ~ P ; A ' t . : ~ ; - ~1 - • ~ - - - - _ - - - - - - - "S CiECEASfD FvER ~N u.5. aRr1Fp F~~RCES~ ISOUai Secunty No. i 19. FUNERAL MUME AGURE55 . . . or unk~~uwn) (11 ycsA~ve wa~ or Oates of 1¢rvice) ~ f. ~ ~ 1 - ~I . 'OX ~ - • ~ ' ~ . - ~ . - ~ ~ - - - - - - - - - - ~ . . ; t ~ ~E R'S NAfAE - ~~20. INFQHMANT ftc~et~~>n~r~~p „2 . , - ' ~ . . • - . N _ . ' ~ • . . l[ ' ~ c% • ~ • _ _ . _ _ - . ( HEi2'S AlAIUEN NA~rSE ' l, iNFORMANT'S AODRE55 ~ - - . . - - ~ k . , . : . . . _ - ~ _ _ - - - ~ ~~:~;f J~ O~TH~e~ only one cause ve~ inze lor ~a),(b), ana(c~.T6Z-A _ RiFVT-- ~'inte~va~ tieEween ~'~olVOl YiliTe in This 5uace ; ~ onset and deal~ ~ 1. ! ~-~.<< t t. pEATH WAS CAUSEO 8Y: ~Mh1EU~AlE CAVSE (a) j 2. 3. 4 - i ~ • ;~,s ~f any. GUE 10 IGI-_ -T---'--t---------- - ~ ~ :.,.c ~,;e to - ~S. 6. c ~ ise (a), ~ ~ .c .,nper ~ ~ . 'r .e ~as1. ou[ ~o _ 4~1. - 1- - - - - ~1. Otn - CI Cryn~l~i.f.~t ..~acS~!~~-~i~ curt~::iut~rv.~ in ~:e.aFf. Lut ~~ot reiated to ihe ter~~una~ d~se~sr cund~'•~.n ,-i~ven in J.i•t !(d). ..'3. A1J ~t~l'SY' ' ' V•l ' ~fV.. , . _ . . _ _ _ ' ' ' " . . ~ .i't i+A!!c~N PF~ Nf i)H6'f-U .'Ja. .~ATE f~f -f24D Ct~NDIT~CiNS FOTt •.'If!~~`.t1 !.'F~7Lfi~E~~~~ .'~~5~ L~4tT~i2«~~) . . . . ~ .'c~!e I:r:; , 23•a snJ Z3~D ciPCR4T1f)N ~ - ~ ~ ~ ~ - - - ' - a - . . ' - - . _ . ' . _ . ~ -~b- ~ ~-.F c~Y5~1'i ~i , , T' . , . T;~~„ t ~.rcDy Ce+:~ly [t.Jt ~ at'er~A~d !t c ~[iCas~d fr~~~r, ~,~~~~~2-- { ~ / ` G ~ l~t ~ , . tu _~t~~~=T~---. I9 tnat 1 iait saw tr.c aatcasc7 7-_-_- ~ _ _~1.-22-~7 tA~3~cis ~ . 'L::~~ , t .19 .ae~ cnat : •~z •s,~.. z,a,.~ ~~~„~e f 702 Meado s Lane V~ d ia, Ga S-27-7~ ~ ~ ~ ,,~<„•.F •.~t n;< ,~t ~ xn~~~~~ K ~~tiYti1CIA~ s PidC[ ~.1 1 + 7:.}'~ Y•~d' (.i ,.:r ~ . :.e..lUEtiT ~ ~'~lury tr.q. en ~:i s::~,.,t I•.~~,ry!>:eur~~ . (C~ty .:.r i,,wn) { ~~.•`~-tY) (~..~tc) 'Timr (~.t 3 (:r.~r; 1 ) t ~ ~.l~C!DE r~ ,~~~e. f,nn. lai.tory, ~Leet f ~ YJn~le at wo.k . `-r d .,•.ICIf~E ~ F~v!l,ce Gtdy.. e'~_.) ; M~t wn rt at work ~ ` ~ Ir;~ur / . ' ~ ' _ ~ _ . . _ . . . _ . _ S .S~d ~n~~.~y xtw' . ' i ~ . . _ . _ . . ~ - - - - - ~ - - ~ . { ' SF RECE~VED ~ Cnr~.,r,cr ;S,yna:.~r¢ ~~.:r . [ . : C>uOtVER ! j ~ 6 ~ ~ . - ; --{l~-.- . ~ - _ , ~ 4 . uFC'fiVF~C~ 30.:~fG~`tc,:.q'c~:.':Ai~:~+t - . ,sy,~sl- _ t NE Gty i:~AR - ` ~ ~ _.7 , ~ 5-2_7~7?_ _ i_. Q~orge _Donovan _ Vidali~, _Ga 5- ? 17 ~ • 3 tH.~.. e-~s, - - - - - - - . - NOV ~ 32 ~K'~8 § ~~LED R~7 oECOR0E0 s C~P.TIrICAT:; Gi Ft~CO:~D ST.lUC1E :ObMTY,~~~. _ _ - ~ KocFp Po,~a~s - , ' C~ERR LiRCUIi C~U • ~ " " " ' RECORO VERIF~EO This'is~~ exact copy of the death certificate recefved for fi ~n3 ~ ~ Toombs C~'~ ~ ty, Geo gia . ~ 222~~ , . . . , , . - - ; BY: ~ Lo al,Cust dien of Vital Reco s• Locsl Custoai~:n~~ Offic^ - f ~ ' a Toambs' Count Geor fa k - Date: 5-27-77 ~ SEAL ~ - t ' ~ o~ 2q~ ~2 ~ - ~oo~ . , ~ _ . _ _ _ _ ~ _ : ~ . ~ ~ f 1 i f~ .c~''-e~.~ - :r $<:i...~ ~ .~'~t3~~.a. . ~ ~s _ . . ~ , . _ „b., ,e