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HomeMy WebLinkAbout0630 NOY / ~ sl rn i~ / ~;~1553 :T.`~~~`«*~~~. 'C ~C~ER ~O~TR1~i ~~EA~ GRW~~ C ~ ~pit0 vEA1f~f0 ~ ~'~1553 HILLSHOROUGH COUNTY HEfiLTA DEP~IRTMENT ' 1105 E. KENNEDY BLVD. TAMPA, FLORIDA 33602 TELEPh0,1E 272-6390 , _ ~ . CERTIFiCATE OF DEATH ~ nty.rrl.ne.~t ~~~a~lti ~u~ ~e~+a~.:Iil~tire Gc~ricrs ST/1TE FILE PIO. o~~iau~ or ne ~i.~ n F L O R I D A [:NI IN M.i.YM.n.a~•~rwa ' ~ t ~ REGI£•TRAR•3 NO. ~ ti I~:K IOt OECEASE~-NAME ~~~t~ y~oae w~ SEX OATE Of OEAiM ror~tw, o~~, ~ ~ JOtII'J SPEIlCER BURRO~S : N.'aZe Se tember 1 ]970 RACE rw.~r, wio~o, ...u~c.w ~MOI~N~ wGE-i.sr u»a~~ ~ n.• u.~e~~ ~ o~• OwiE Of LUtTH ~.o..rr, o.r, COtlNT9 Of DEA1N ~K. t~~C~~f ~ pu~O~~ 1 tf~~fl rpf. p~~f MOVq rw. riu ~ ' Nhzte 67 „ k ~ Dec. 23,1902 NiZtsborouah I~ C1iY, TOWN, OR IOCAi1pN Of DFA1M . waw c.n ~r~q 11QSf1fAl pR OME= NSil1UT1pN-H~1Mf ~a 1.0~ ~N Ur.u~, ~w~ s~a~~ ~..s rwuu !I~(Uf ~fl Ol MO -„j,. Tcnrrpa No (Iniversit• Canr,nozity HospitaZ STwiF Of ~:~TM ~ u Mo~ u.s..., ...r~ CIi11EN Of WMwf COUNT~Y MARUEC, NEVER ~wRtiEO, SV~vIVMlG SPOUSE ~r wM~, ent .uoa~ .....e ~ cou...~r ~ Mn00wED. O ~ wc~n ~ l~innesota . USA lfarrze~ Etsie ~Ihyte ,w. SOCU?t SfCUR~TI/ NUMlER USUAt OCCU?AIqN ~a~e cw w v~roac oow~ ew~.~e .w~~ M KM~p Of 6USWESS OR INOUSflY • rota..o ~u~, at« N ~~~wro ~ ,y DLZ~ector Sales Training Cenerat l~otors 1tESIDENCE-SfwiE tOUNt~ CfT1/, ipWN, Ot IOCwT10N ~M~ ~~r+ ~rns SitEfi wN0 rtW.?~ER ~y~''ZOY'LC~C! PQSCO ~±~eew..es o~ Mo Lcmd O'f,akes Mo ,~,Route 1 Box 542-H fwTMEi-?~,~Mf ~,~s~ r.oae i.v wOiNER-M.aWfN Nww~! ~ru , r,,w.~ uu ~s • John • Burrorvs Edith S encer 1?+FOiWwt~t-t~~E MAKWC, wOGRFSS ~s~ntt oa ~.~.s. wo., an w*o~», v.n. sr~ Mrs. Etsie Burro~s ~h Route 1 Bos 542-H, Land O'Lakes, Ftorida fwRi 1. GEAiM Ww3 UUSEO tY: ~Er/ifR Or+IY ONE GUSf ?E2 LWf fOR (el. (Al. ~frp kN o~.sa~ .+~~w?~w u_ r...te..n c.us~ . ~ - ~ i ;:,~t~z~ ~G~i;/~~'U' : ~ ~ (OMOIl10M1~ 1~ 1M~~ , MYICM GAV~ ¦Ilf t0 ~S~ r~ v G ' . ~~l~ t~~tO1~Tt C~Y~~ b~. ! ~LT~M4 twf Vwp1t- ~ t0, ~S COMftOVlMC! O~: . ; I~IMG C~YSt \~tt ~ \ ; + kl ~ IART M. OiNER SIGNYK/Wi CO~~DI7pNS: ~~~~ows epnaaxn.~G q W~u wt «Ot nureo to u~s~ anrtw w riut ~ p~ A~~Y N YES v~~~ ~~w~~res eo.? i Ittf O~ ~!01 t~M~~~ IN q1l~WwYp (~Yy ~/,r~ W 0~~1 ~ IC~~ ~ Ib. ! IfY . ~ - _ ~Dt~ Ot 1MrJ(it~iwwEO~ Ow E WNRY ~ro«~w, o.:, Hpu HOW INJURY OCCUtREO ~ ~~n~ r.~wt p n.wn w r.u ~ p ruf u, wr ~n ` ~ ~bl ~ :i?- M. 201. IPWRt AT WORt ?IwCE Of 4r111NY.~ ~o.~, u~u~, ~.a~r, LOCATtON c s~an o~ ~.r_e. w0., trn o~ to~., u~q ~ lfltd~t ~!S O~ MO~ ONKt ~tO4.,~K. ~f~tCNt~ : ~ ~ ~ CER1WC~iqN- .o.r~ o•+ n•• ro..rw o.• ~ua 1++0 Y!f L~ ~r/Mf ~{M ON 1 OO/MO rqt ~n~r 7w! OEA1M OCCV[!!O s~ w~ce. w ar ~ ?ti~sK~w~a: TO ra.ti o•s ?w ~om .n~~ w.~. cwa,~~ ~~n, wo, w~•ew ~ ~ne.row rwt G y ~j ~ ~k e~u.s~o nor O T~ ~ C ttl / / ~a tlc / - ~ M r¦ i..O..ueu. h~f ~ ~~t. jl• 10 ~M[ 4YHq~ SLNO. ' CERTti~CAi10N-AtEDKAI EX/V~WER OR CORONER. ow *.t ~.vl d ~wi wo~r or oe.n~ *~e oeeeoe..~ ...s ?~owou«po ot~o - a~~rw~ti0i+0~ 1w! ~OOf I~rO/o~ tM rnts~~G~rU~+. w r• Orw~Ov, rOtitw Wr itl~~ wpy~ N~b1 OCCW~lO OM M( p~/! ~w0 OM IO ?q UVS(~t/ 1~~~(O. ~ ~ M rn x N CERTri~fR-lVAME .nn o~ r~w.n SK,NwTNR~ r_~. _ eea~~e ne OwiFp5~ W+FO ~.~w+~, w~. •e•~~ " ti'- 1// /`~lA~il/ CGlui.~s~ L~tl.~c~ !v'~ . ~k / ' 3 - `7' v ~ ~uar+G wOO~ESS-CEen~e~~ s.ner oa ~.~.a. ..o. un a~ww s~., tn ~ p _rf%Lo ~ r~ l~ d ~ T.¢ /vi / - ~11R~~1, C4EMAi1pN, REMOVAI EME1tfY OR CRFMASOR~-N~f IOCAl10.1 ~r. o~ q~... s~•te ~N I S~fCr7 ~ ~ Cre~r:ation l.'oss Crematory ,<<. CZearwater,PineZZas Co.,FZoridn + wiE r,.w~w• w?, re.a~ fUNfRwI HOwE-NAMF Awp ApORfSS ~ s~rnr oa ~.r_o. wo., an o~ ~or.., yut~, n?~ ~ ~y e t.4 1970 n. F.T.BZozozt Co. Ft.rnercrZ N.o~p 7 lo S ~ n ~ ~ _ ~ REGtST -•iUfF ~ D~tE ~t NrtD tl • NR~~ n ~ ~ T ~S/u-/ i~. / ' :w ~,t " ~ 70 _ ~ ~ I NE~:.4i~~.C~:R':'7FY THE ABOVF TO B~ A TRliE A~TD CO:L~ECT COPY GF THE LOCAL ?ZEGTSTI2A~'S = RECOi2D b?2 2'ZL~ Y`:t' :t'H'•.' iIILLSB0~0[3Gii C`J(;I'rZY HEAL Pr1RT:~i: vT AT TA*!?~1, F1.ORTJa. ' . ~ . ~ , ~ . ;S . . , tY ~ ' , ~ j ~ ~ ' • ~ ~t . . ~ _ ~ ' ~ ' A~ < . o~~ S. Ie+cill, t4.D., P:'.P,}{., Direc:.or i~' A({G 2 2 j~78 County Health U~;icer F: Local Resi ~tr~r ~ ` ti j f i , S ' AE~TE . • ~ y- ` (t~OT V~~LID Ui+i~~5•'ItAISED SEAL 0= THE ~/`'T~G~.~~/ _.=1" HILLSBOR(7UGH COUt-ry }{El,LTH D~PARTMEhT Tneresa ri, Lup~ens, De~ut"~ Registra: IS -AFFLtED) IF'. . . • _ . . ~ - • y° a~~K f 2'~ ~ . : ~ _ _ . ~ : ~ . . . . : ~