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HomeMy WebLinkAbout0933 ~ i ~ ~ < . ~ . . , ~ , . ~ s; . ~ tY' i . ~ ~ , . _ „ _ , _ _ _ . . _ . . - -428425 - - : - . . . _ ~ C~~.TlFICATE OF DEATH ~ . • • . f . ~ ~ ~ R~~~~41f~ F L O A I D A ~*wTS FiLt N0. r~:801 ir~E. Ot ~t1?n ~I1 .u...c•w...w•*..es R[d1i71lAw•s NO. • N\~RAN[t!T INR OECEASED-N~Mt ~rs~ rwu ut~ ~~i ~ SEII OAT~ OEATN ~ rOwtw, NY, u 1 . "~'~f0~ ~ Doroth Schadler Jackson ~Female ,Dec~b r 11, 19~8 ! . RACE rww. wecw..wNC.r «.wr, wGE-up wet. ..w .~~r. QA/E Of MRM ~.w~, w.. cOUN~Y a OEAM • y ~+t. ~wcr~~ www~~~au~ ros. ~+e ww~ +w. +r+i y ~ White 52 s~ ~Oct. 20 26 ~Srevard , iOMM. O! l OEAM WMMet^ w p MOirltAl Oll~t NST - ~r ra rr ~w~. aw s~N~ w w.n~ ~ I ' ~ Rock1 e k Yes D.~.A. Nuesthaff I4emorial H ita iiAtE Of M~M ~M Mm r ~.s..., r.v Of wM~T COIJNRr . MAR~IEO, t!v[a MAYRO. S1~vN~1G Srolfit ~r .w. swT r+sw wne ~ Michl~n `°"u"' ~ U.S.A. woo~.oMOUro~~..~ 8ernard A. Jacka,a~ sOp~t sECtM1iY NIW~Ee u3wt O[QI?AflON ~w+~ w a.w¦ ~ar Mwr~o .~oa a it~+D of ~+ESS Ot r+Dlrsm OOqiYS M - ~O~tMC Y4, l~7M O~tM~ 1 . n _ _ ~ School Teacher ~a. Public Education • ; ~~wf~on. ~E5IDENCE-SiATE COIMi1Y GIr, iOW1~, O~ lOGT10N •+sw cw wa :?~T ~ ~ . ~ tt~tt~e ~q p w ~ uF2orida ~•Brevard Cocoa Yes w 59 GrandvieW Circle fwi/rtR-NiwE n~o r~~ ' wt M?ORMEl-MAD[N NAME ~+u .rw~ uw e j n Emil - Schadler w I,ucile Narti ~ IN~ORMAM-NAIME MAINQ AOO~Eii ~s~w~ w a.r.~. no., cwt n w..., ~uw. H~ i . ~k I+Lr. Bernard A. Jackson 9 S. GrandvieK Circle,Cocoa ~Fl ida 32922 ' ~~t ctwm wni causEO ~r: ~ oytr o+E uuat rK t+rt iot ht PL ~(r~ • ' ~ r~ii.~. o~M* .rs +r.M ~ M. ~ C.'.I~cOi i1 c ARR Y r' N n t S ~~~o corwno¦s, r uw. ~ t R J 4 /L 1 . ~wKr o~ot aN ~O pl M~~ V h A T 1 t ~~~T 'f r= ~9 ~t 7 uwwn c'uu w, we ~o. O~ tl~ OOwYOMrp Or: c ~~~tIM~ 111~ rM~~ lmN tNrN ~Ap . ~ , ~ ~ ~A[I OT1ER SIGNrICwNT COMOR10~4S: eo.~wous eo.ewrw.io ~o ~e.ir w~ nw ~..a~ w e.rw o~n. ....n ~~a wV10KY • rEt r!Y lINMM~f Cpf - ~1tf O~ MO~ Wt~[i M Nt~WriMO GIYf! i . - Yes w. Y s ~ ' Ot Y~OlTiwMO ~ rwr~, •w' now uwar ottueeEO ~ ewn~ wnMe or arwin w~ r~n ~ o~ r~n w, aw w~ ~ ~ M. 7M. ~ INlUR1f Ai wpR RKE af NIURY u wwr. ~a~ s+~n. ~.t+a+. tOCw1~OM ~ aua w ~r.~. ro., cm oa a.u, s~aa i ~ ~ swan ws w ro r ow~u rw., ac. ~ swcr~ ~ . 7h. ~I. 7y- ~ CE[fi1G110N- .w.nw ~.r n~r nowM ~?r •w rue wi s•vr rW~ une or ~ w/w w+ v~nr ~t o[wtw OCCw~EO ~r w~ w~tt, w we nnsKUw: • i0 "o"'~ n.~ ~w+ .nea ~e.~.. ~.ow ~ w. ..y. +o .r aa ~ ~ .m.~«. a. N/A m ~ w ..~o.~..oe. .~a.,....o. ,a. Did n.. r~ .o c.~n.w s~.~.. : . ~ CEITiKAtqM-MEDKAt QMr~WE! Ot CO~ONE~: a. iwe s.s~s a w~ woM a a.r r«e acea.n r~s r~owoiw~ce~ ~w - !"••~.'UO+ OI M~O/~ ~M/p N~lt~tp, ~r ~n O/Mp~. ~OrM y~ ~tY npy~ " ""'M "a'"' m Dece~aber 11, 1978 ~ 7 : 30 p . : eN,M1E.-NM~E a... w...m o~e~te or .n~[ , ...,.u.~ r,. Pablo Enri uez M. D. ~s. ,y D 4,,,.. ,~ij_7 ~ ~ .y?a,~,c ~ooUESS-Q u..a c. a..... ..o. cmr « - ~0 South Aiclco Street Melbourae Flor~a 32~T01 /{JMAI. QEMATIOM. ~[MOYAI OR dE1Nl?TOR~-NM~E IOCATIOM Crn O~ IOw~ !LN ~ f~KMt ~ Cre~ation Cedar Hfll Crematory Daytona Beaeh. Florida ~ ,.,~Dec. !u 1978 ~ ~~it~i Fu~ne~~`~e~F:i~".~~:d~.~QBox~~~j;~~usville,Florida 32~80 - Y. S. f612 ~ Of- • D~1E ~ECEnEO lOtwl ~E6~tiW ~ R~~.19T0 #1126 , K? December 1 1 _ i i ~ I NEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE RECORD ON FILE IN ~ THE LOCAL REGISTRAR'S OFFICE IN THE BREYARD COUNTY HEALTH DEPARTMEN7. ~ ~ (Not vaTi~d;~~ie~~;~he seal of •the Brevard County Health Department is affixed.) " c,`~ ' • , _ _ ' a ,d . 7 . ~ . ~ : ~ ~:t~'~~. .Ki~~~ :.?i~~ R~~ORDEO ~ - ~ ~ i: ~U~~TY fi_ ; ~ • ~r - _ `t~ ..<~?'<~,~'.[~{~~f.~~[f ..^~Y~ V • ~ a -...f1I'/ ~ ~ _ - ~ . : Lo a. Reg~strar ~T$ Qr~ 26 P~! ~2 : 32 . •~~~a~~~~. • DEC:.~.4 ~978 . . , ~ Date 8 Seal - c~~.s~-: ~ Deputy Registr ~ - r. ; ~oa~ 3~0 ~l,~ 9~3 1 GF.!1E Pr}3ER7c 'r~t ~ f~>r~~E VALM.$I~ELE- LEEWENNEA ' ~a~s~~-.:.~ :t~:~ ~ ° ~ElellC . _ ~ _