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P~.lni 13~a.cli ~;ouil~ v ~-ie~,lLli lle~~,rtment '
,ll,lr•Itl i~illlfla, CER'1'il'ICATE OF UL~ATH
Ueputment of Ile~lth and Itehnbililative Se~vicert tTATE rft.e No.~. _
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PEnhfANENT ~ _ _ Luther A. k~illiams 7n~ale July fi.197E3
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Florida Palm Beac ,.t Ulest Palm F3each No 2~i49 Cherokee Ave. #
tAttttl-NwAr( nep crepe lest MOWER-AUIOEN NwME rnft rrOOrf uft }
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lrpORINANt-NAME MAR.MdC: wDORtSS nnm oe of a rro. ca. oa tort, fun. frt
Carol Owen 315? Riddle St. I?Jest ~alm E~each,Fla.
rAt, I OEAM WAS CAUSED 1r IN?tR CMrlr ONE CwuiE /ER IWE ,01 e 0 wNp t ~ r~ f •
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1? 1 ACCIp flMrt)! t~ A}~E~ 1 rOrtrl, wr, qu1 NOUf NOW IURr OCCURRED 1 frrfe rurvaf o1 .rwn rr rut 1 M r•n u, nw ter
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"v CER1YKwf10N-MEOKwI fiwMWEf OR CORONER o» rrt a•trf M ,wf rrOYa o1 a•rrr trt olctav«r was ?ao«oo.rcfe of •o
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ourw occwaw or aw e•n .ro ea a rrN c•Yffrfl u.rw
77a M 72e _ _ _
CtROEtER-NAME rnn oa raven 3iG+J~tUtf - ~T wtf c... OA1E S ED •t••
74 0 r_. A 11 e n S c h u 1 t z 7,1, ~..Q..Q-~,~~ <S c i%C~ 7><
/AANIN(sAODRfSS-cER?LL01 45th Streetttt~UJest Palm Beach«Fla a 33407 tr rf
\r r, •97 Itl? {UR1Al_ CREMATION, REMOVwI CUAEtERr OR CREMAtORr-NAAfE IOCAl10H On oa rpwr. tr•t1
F ...•Y3all,~VS r NfCr. r
E 7.a Burial _ Ile Hi_llcrest _ _ 7.c blest Palm_ 8each~Florida
DATE rronrr, o••. rt•u , tUNERwI HOME - ?uAat aND ADDRESS r traftr o. r 1 s »o , cn. o. rov», srar• to •
Tae Ju1~8,1 Ti"IIm~1s 270 So. n~ilitar Trail UJ.PaIm Fieach Fla.
tUNfRAI E OI- At - REGIS A1DR( Oatf efClrvfO e. lOC •1 efG,Sq• -
, -
i
' I HEREBY CERTIFY THE ABOVE-TO BE A TRUE AND CORRECT
COPY OF THE REGISTRAR'S RECORD ON FILE IN THIS OFFICE
_ ~ (Not valid unless the seal of the Palm Beach County
Health Department is affixed)
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' C.L. Brumback, M. D.
~ July lB, 1978 Local Registrar
_ Bureau of Vital Statistics r:
SEAL West Palm Beach, Florida
P
Return: John E. Bollinger, Esq.
;3 315 Third St.
West Palm Beach, F1 33401 ~~~`35
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