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state of Florida CERTIFICATE OF DEATH RrrATEt E{I~E~ rlo.
pepartment of Health and Rehabilitative Serrices F L O R I D A
VITAL STATISTICS REa1RZTRAR•a No.
.uteU t•tr SEX DATE Oi DEATH ~ t•oerM, e••, ~
DECEASED-?+~ 19 7 8
TYPE ON PRINT PATSY UNDE_RHILL MENNINGER T Femal , Ma 3,
PERMANENT r - - ; C+±L+t*r nt OEATN _
RACE arwn, Moot», •watc•M MMN•M, AGE-wr w+eea t n•a w+ott t tu• it. i;::c.:_:::: _
BIACKINK a.arMe.• tn•att t.os ~•t ~ Martin
tK. r tttcr• t 8 2 ~ . Au . 2 3 189 5 -
. White 1. _
wtgt cr. u?es 11pSMTAI OR OTNH RdSTITIR tr trot tM lterlt, 4t•t urn ..M rtttrttt t
CRr, TOWN, OR l 1 DEA1M trecrr Nt Oa ao
Stuart es Martin Memorial-Hospital
MARRIED. NEVER MARRIED. SURVIrl,G SPOUSE tr arrt, ern rr+nr M•+t! r
STATE of RIRiN tr Mot w tt.f.•-. watt CITIZEN of ww?T COUNTRr wgOWEO. , VKrrt Henninger
. Married I,-Edwin A.
attw rtMMtt E Missouri ~ USA N
.trr etct•re SECURTTr NUMBER USUAL OCCU?ATION ta.t awe or waa eottt twatrto t.ou a RIND Oi EIISNESS OR NdDUSTRr
,trra r w,ie1 a,~,.,. pq, MM r rnaN t Own Home
OCCwate w ITi.
~M•°^" 1,264-28-9801 A 1,t Housewife wtptr.tt.uq STREET
nueetrct rtnr CIri, TOWN, OR LOCAl10N
•erfuoM. RESIDENCE-STA/E COUNTr rtncr• •p W Mot
L_~ - Itt ,w 129 Martin Ave -
Ita Florida IM. Martin w Stuart r+sr _ Ott
- Wt MOTHER-MAIDEN NAME _
iAT"E'-"A"tE Bella Bender
„ Geor a Underhill- I,
INlORtRANT-NAME MAIRJG AOORESS tatrat o+ •.:-s. ++o , sa~r tst to~+. at•w, art
I/aRobert J. Williams „f P.O. Box 881, Stuart, Fla. 33494- .
. ,r•
ENTER ONtr OPE'CAUSE IER tNE i0R Nl AA Al's kN wraneM oran twe ea•wi
- rARr 1. DEATH wAS CAUSEO ar: !
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COMNt10Mt, 1/ .Mr,
~I rMKM Oast attt q h~
t.atet•n c•ett ter. e„t a, a N ? coMtaattMCt o.: -
atArtMe rrt eMeta.
rnM. tatlN wr
kl AUTOKr M rES .ut nt.aaos
COtMrtettt COMMaltrt0 b M•rM aw rtet rune p tAaft OnM w rYt , NI t* 172 t p et•,•M ttrtarrwrq
TART R. OTHER SIGNIIKANT COt' (V
M
NOW IN,UIr OCCURRED r tMta Or t'tJeM w r•ar t M t•tr M, mr tt r
p~!~1~~ A 1 MpMtw, Y•, •t•a t
MD11tIQ0E, OR IRi>~TE4tItIED
,Rl. 7k M. TY.
INAIRr AT WORK MACE Oi NIURV •t trot. r•ar, fttetr, r•cron, IOCAl10N , antra M a.r-e• e'r• « ro.M, u•r t
t frtGrr rat Oa MOI OwrCt Mee., tK. 1 tnCrr 1 ~ .
MOMtM M• •t•t MOMM tu• tt•a AMe u1t f•.r ,rtr/ttla Arnr! OM t ere/eq a01 •tt.t M etAM OCCYMIO AN, b M
CERTIfICAT10N- rroMa e•• nu tee• • ~
10 ~ ~ ^
TO ~ Pp r• artowtttwt
rMtSKtAtI: ~ ~ ~ ,It ~ • EIE • ro wtt cY,ttgt t n
r •mMets rw , ~ ~ l . 1D.
Aa wct•fte raoM etct y noutouMue w•o
CERTIi1CATION-MEOICAI ERAi,IINEt OR C R: oM tMt usq o. tt! Mow o. M•rM rOtrtM e•• nu Mow
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ta•r.r•*wM a ate tw• •te/a ttr w•ttrto•ttoM, w r• awMlrt,
tM•1N OKwre OM M MA rte e1R q Itrt 4Yitg1 tt•tte. A SK,NErD
,+oattt O••, n 1
TTa SIGN E caterer a tmt J
cERTIiR:R-'''"""E"rr`~}r"M Grossniclcle,I;.D. ~
James ~ ar.4 tr
„a rrr a.r.o ~ w to.M
- a~AaRaG ss-CERTMJE. cean Blvd. ~~u:.tr , Ala e l_~
T,/ 23.11- r ~ 5 O LOCATION c,r• a to.n+ rt•n.
BURIAL, pEMATIDN, REMOVA:I EAtETElr OR gEMA10Rr-NAM[
tartcrr, STuart, -Florida
,I. Burial _ Fern Hill Cemetery T.t
pwtE - trwtM, a•, n.at iUNERAI HOME-NAM[ AND ADDR[ss t anut of a ~.o to . at. o. roots, rt•tr, art Stuart, Fla 3 349 4
5~ 19.78 }1.7ohns Funeral Home 961 Colorado AveAt a It•te a. t«Ar n tst.A.
RE 1 -,KNAiUEE
V S. #612 fUN _ / GtS Gf~A
I hereby certify this to be a true and correct
_ _ copy of the Local Registrar's re en~dinnStuartln `
the Martin County Health Departm
'Florida.
f-" :~s ~ ~ - Not valid unless raised seal of the
- ta'; n (Warning : artment is affixed. )
" t~ ~ ~ ~ e Martin County Health Dep
_t McCallister, M.D.
rchie Re ist'rar
f=` ~r n ' ' ,~Ft~i Health Officer & Local q
_ - - - _ t
.ate>~- ~4;z`7964 y~ t
1.. i. ~
' ; ~ ~ s Q,~ ' ~ ~ ~ Duty. Req r
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