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DEPARTMENT OF HEALTH ANO REHABILITATIVE SERVICES . . ~ • • o • STATE OF FLORIDA ~ /
DIVISION OF HEALTH
Alachua County Health Department
Tekphott~ (904) 378•'5321 816 S.W. 4th Awnw P. O. Box 1327, GairtRSVille, Florida 32602
saaorFloriaa CERTIFICATE OF DEATH -
DepartTllent of Health and Rehabilitative Services FLORIDA s+TwTe FIE.s No.
VITAL STATISTICS n1:GlsTwww•~ No.
TYPE ~1R PRINT O!ClwSEO-NAM[ ,snr rswat asst SElt DAiS Oi OEwiM srorrr, e•r, •r•u
Ilv ~ STERLING GARY BENNETT JR Male , September 3, 1978
PERMANENT
BLACK INK RACE M+te. wo•O, •ra•rt•r t..e..«, wGE-a•fr vwt• t n•• slwpt• t CwTt Oi WRtN Ira..». wr, COUNTY Of OEwTN
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[ 6 - k - • 5/2 17 Alachua -
10(E CITY, TOwM, OR lOG OE OEATN s»ssw cw. ?tssMf /rOSMAf OR OTi/ER RiSTIT N tr «Ot tr rtttw•, ON[ ftwrt •«O •s•+r•r• t
sr[ttn of a »e
Gainesville ,a Yes „ Veterans Administration Hospital
~ STAT! OR MRTN t w ror w r-f w.• Ci11ZB[ O[ WHAT COWiRY MAIRIED, NEVER NARiED. SURVIVING SOUSE t» .•rr, Ot•[ r•,oa» •t•rt t
„,,,,K, s. Florida ta.ant , U.S.A. ""°°"IE°'°IwR°E°""`." t/. -
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i,rtD. r Oe•1t SOOK SECUMTY 1'afMRER USUAf CR:CU?ATIOW ttY•[ •rN o. sr0•• OOsw ON•n•O rust W KRHD Or MIStN[SS OR INDUSTRY
OCCVt•NM •/p••»Ir{W/~Q~1rb~•rNtMfi1 `w+A p ~.w.•~,w,~}
,+sntvrspr, 6M IT 1~. Ownen.'~pe/ta~aa I>. RQ.batatU~ant
re LOtMC! Mr0•[
.pr,ss.or, RESION[CE-S7A7E COUNTY CITY, TOWN, OR tOCAi10N was•r csr• ts+tw SitEEt AND NUM>tEt
tatlt«• of p n0
1/. Florida Iw St. Lucie 1[a. Fort Pierce Le 1... 1315 No. US Hwy ~ 1
iATt1ER-NAME rt•st rswa[ a•st MOTHER-MAWEN NAME Near t.soot[ t•ft
If Sterlin G. Bennett Sr u. Stella Skipper
1lafORMANt-NAME MAxMKi ADDRESS tfnot a t.o., csrr d tO.,sr, fr•w, asrt
~ v. VA Records In Archer Road, Gainesville, Florida 32602
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DEA1M WAS CAUSEO RY: IENIER ONLY ONE GUdE IER LINE /OR ANO (r •rrprsr• ,r ••M '
1) nr•ru« o«sn .r n.z
Is twwwcs[ ~ iilJ h~COP.DED
! 1.1 Cardiorespiratory Arrest - ~ , U~;TY, E~,,~- 10 minutes"
• - - ~
ct,t.aaa»:, r..»r, Metastatic arcinoma ~1a~4 2 months
.«sc. a••[ us• to isl
trwa•n c•ws tsr?, w, to, o• •f . coatrou•s•cr o•:
e ft•tt»O tM Y»N~
f ?ARi M. OTNER SIGNI?1[/WT CONDITIONS= eossa..ws eaw.»ws«o t0 w•M •a «or noses q c•.srn er7r sr r•n r te? /L AUiCNSY N YES vr.t Nrs.«ea co-
a 1- !7!f O• »OS LMn. Ir Mt/lrwtr6 tMl-
1' - J W Otat«
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pnlt~.Mrl waCJDEn1~iE~OR A INIU 1 norr«, w•, •e•• t NC)l1R Ht~ Ret~l~f OCCWIR[Q ~ r»wr;rt~tt~ror srwn 1» r••t t o. pan nw s.1
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INJURY Ai WORx r1ACE Of RVlI1RY n ssa.•, a•r, frw•r, !tsar. IOCwT10N t sous o• •.t-.- u0., csrr o• ro.rt, stns t
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CERiIII(ATSLM[- r.aa« M• MY rp»M N• •!•a A«O Mft s•v «r/«n •t.+r O« t tsso/eto tAt •srsr Mr OE•t» OCCY••[O n tr! rs..ct, O« O.t ,
tftCuN: TO ro•srss o•t nu •OM •rN• w•tst- tssOwr Nw, •r0, t0 tsst N:r
~ x•~»» 8 7 78 9 3 78 g 3 78 ,1,. did 4:.15Px o n„`
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was. rqr Ill !le
~ CERTIfICJ?TION-MEDKAf ERAMaifR OR CORONER: o.. rw• a•an o• tsar wo,sa rr w•M sre otctot«r ..f t~asoss,seae w.o
~ ~ [•ArM•1tD•• O! T/1f •OOt •«O/O• twt •rrtfNWryp», W rr prtpr, r0«M O•t •t,.• rspVt
w•tD Otgl••to Or •K O•w •rO OW t0 rw[ 4rrafrat ar•r10- -
CERiINER-NAME ttrr[ o• ?•s«n ' ~ ~ ATURE i/~"/+ wn o• tsn[ »ATE~ t~r, tt••t
RICHARD JACKSON M.D.
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MA4WG ADDRESS-CERTNIER u•tnro. u.o w- un o• t a•n tsr
7l[ 2
BURIAL, CREMAi10N, REMOVwI EA?ETERT OR CREMAiORY-NAME tOCw40N un of twr erne
~~~~~"emavaL- ~ P~.neeh.es# Cemeten 7r. Cocoa F~o/uda
DATE rr0«M, wr, nos iUNERAI HOME- AND ADO>SS t fntrr O. •.r.e, r0-, tdt O• tpr», fun, rsr t
u 6 197k d H m 901 N". '7 F~. P~.enee, F.~. 33450 "
~ V.S. y~6T2 /VNERAt OR wfU REGISro R •fURE _ •nn Dwl[ •[cssvEU.r toC.t •tGtsrrw•
Ft w- x/76 ~ / ~ 7a. ~ ~..d! - Tw Se tember 18 1978
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"r I HEREBY CERTIFY THE ABOVE TO BE A TRUE AMQ :T.•COP~t`~OY THS DEATH
CERTIFICATE FILED IN THIS OFFICE. ..-3/r - ~ - "
s •:~'I.
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DATE P ~ )~~Q MYRTLE TROWELL, ~DW/2PUTY REGISTRAR
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