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Home My WebLink About0166 , C ~ ~ oc PROBATE NO. 78-463-02 H ~ : ~ , ~O 'r_ _ ~ ~ a0 ; " , c~ ~ ~ . N ~ ~ O v . ,v _ , . ~ ~ . • , . StateotFlorida CERTIFICATE OF DEATH ? Deputment oi Health and RehsbiGtatioe Services - srATC r~~s No. . VITAI. STATI3TICS F L O R I D A ; ~taisTwww s No ; TYPE OR PRINT ~E~~D-~~E ~rMt ?~ft ~j OAtE O~ OfwM ~~O~+tw, ~~t, ~t~~~ PERMANENT ~ ?SCOtt~ H• ~C~QZSOII ; ~oJQ$lo ~ l+iarch 14~ 1~ ~ BLACK~K. ~~~1~. ~.~o.o. •..~.~cu..w«.r. wGE-~.s. ww• ~ ~~+e. ~ C~TE O~ wtM ~~w~.•., C01~+sr W oEwTM # `r ~ • ~ ti~j~1tp ~~~~'n•~~~ ~~ws w.s .a»~ ~"a'n 29, 1914 VOZUSI~3 ~ ~ ~ ~~,~'l m, tOwN. O~ t T1p+ OE~tn wrw c.. u.as MOSMwI W oTNER ~+SrrtuT~Or~-r+ ~r .~o~ w e.u.u, aw~ unu ..ww~ ~ Orango City k"~ s"° N 360 S. _ CarpontA r ~ ~ ' f S1AiE p{MM ~ r ~Wt w ww C1iItEN q WNAT COUNI~r MAltlEO. NErE~ MA[bEO. SUfvIVNG S~OI)SE ..N~. an~ .~~N.. wr1 ~ -D , Indiana `°r"'"~ . US[1 ""QQy'` ° ~ YSV~I C: ~aoW~~ ~ ~ ~.ftt ON~~1f~ ~•eo w M.*. SOCU?? SECVMTY t+tW~E~ {1SWt O~~y?Aiqw ~aw aw a.wa w+~ w~.~c .os~ a [n+0 Of WSa+ESi OR wOUSiRV ! otc~erM~ r~ ~ ~p. FW M ~ ~~~~~~~~.a•~• 292-24-1542 `°l~firoc~ ~"orr~spond~nt-Ch ~~s±ian Sci~nco Church cA e1s:D~..C~ Nq~f IL •o•~~~p~ w~ ~~m S1tEE1 ANO HtlM/ft ~~~ori~a `~olusia ~~p ana~C'its? ~~""'1Tc~'"° ~M1800 Grav~s ?IvA. . . IM 1• 1~ - ' . IATM[t-N~uwE Iu~ r~eeu uf/ MpinE!-wurplN N,u~E ~wr .,~u q ,s Scott - Hankins Efii~ ~hoyminv ~ IWpWANi-NM~E - . MwIING wODItSi ~s~n~. o~ ~ r• w. cwr O~ prr, s..n. tr~ ' ~ ~ric C. Andnsson ~ 415 S. Pl~asant St .,?iinaham, I•f~ss ~ ?ASi 1. OEAM WAS CAUSED h: ~tNfER ONI~ OM! GUSE IE! lr~E iW (e~ A). 4w0 (q~ unou... w t~u ~ p Mr~OUR Nti~lw O~flt ~w~ M~~~ t ~ Acute viral infection ~ ` . cowai.o..s, M .~w, j wwKr O~~f ~~f~ f0 n~ ~rrlMnl~ C~YS~ N~, ~ .fT~fIMO 1~~ YM~lw ~Yf ~O. q ~ COMSt01M~+C~ O~: ~ ' ~ ~~~M{ C~YY t~1f . ~ ~t~ _ . ~ F ~Ati N. OTMER SIGNIfIGWT COliWilONs: ta.s.no-y caa~~..~ q~•p, ~w ~,pr uuqo w c.rsf c.+~. .r •ue AVIO?S~ If tt1 ~r.~ r..w~res co.? ~.ef ..e~ MNat~ anw.wo c.rs; Pulmonary tuberculosis, arrested * 1~0 ~ !?.~l+M~! KGOtMT,~-O~ A ~ rowrw, w., ~e•~ ~ MOUR MpO~MtK~!Ofs O~ NO[iEWY~p MOW INIUt~ OCCUffEO ~~m Or u+ws~ w~~ar ~ p r.~t w. w~r ~ i A ~ ~ ~ M ~01 ~ IN11N11 wT M~ORtt RwCE Oi NJUtIf .r »or. sneu. ~.c*o~*. tOCwnOw ~ s.nn o~ ~ r e..o., tm O~ ~O~w, fT.4 ~ ~annn a~ a MO~ ow.n wsa,~t. ~stian~ ~1 !y ~~~I~ATb?~- tl~M Mt f~Y rppM N? t!Y ~~+0 4f~ f~~ ww/wf~ ~~ar~ O~ ~ 00/MO Wr ~.W 1M p!i?M OCCYMO ~t AM AK~. O+ fM ' ' /Nt3K1~M: TO wO~~tw Mt ~IY ~0~~ ~nN p~1w ~w01M~ ~~1~. ~w0, q M ~lUf ~ ~~1ttM0l~ rw! - ~ p rs t.p~.~~OGf, ti.s 71~ Nu.s~e ~~o~. 11~ tt~ 11 IM K ro n.~ cwx~s~ s..~re; ' CElTYKn~10N-MEWGI EtAMWER OR COlWvE~ o-+ r..~ ~.s.s o. ~w .ow a w.ti ~wf OKI ~.s ~ a .~...~~a ~ a...o.., App . : 4 S far 1 7~~ ~ ~'b • 4 5A ' Ot~M OCtYfYO OM M YM ~~N OM i0 eM C~Y3~1f1 f~~RO q CERTq nrrt IGN oe~~ ~au i o,r, ~ E ~rt"`~iur ~c"Y"iwartz, M.D. . . i '-`~q ; ~AR~~hBlYS'~~ Annex, Room .'S~ft~" Q ona Bea~h°','°F'lorid 2Q.~9 ~ ~URI~I. UEMnT~ON. ~EM~vwl EMETElT OR CtEw?iORtt-~urwE IOUhON cm w wr.. y~.n i ~"""~rAmation . ~Mid-Florida Cr~mator~? . ~ DnLand Flprida ~ e DATE ~ Rwi HOME-Nn~E • A SS t •.~.s O, n• nr r.., ti • - ~ ,J'~arch I°'1'; 1'~78 ~Pn-~umr.~~~r"~ii°~1, 1~~' Vo~usi$, TY*~nro Cit~~, Fla ~ R v.7/76 rtM~ DitECT -S~GwiW[: ` j~! REG~S •~uRE i owri ~t ~.eo ~.~.~[c~snw• tf~ lu jlc ;L~ / ~ x. L n. i - s s ; CERTIFIED COPY ~ 3 - I hereby certify the above to be a true and correct copy ` of the Local Registrar's record on file in the Volusia ' County Health Department at Deland, Florida. ~ . ~ ; (Warning:~ Not,valid unless raised seal of the Volusia ~ • ~~.~c~i.yn~ y Health ; artment is affixed. ) ~ • ~ r~I:~:i~it - : ~ • s , ~ : = - ~ T ~ ~ - County Health Of ce Local Registrar s E ~ - i ~~M~~~-;:-ii. A ' • .:t ~ " ' . ~ Date: Local Deputy Registrar e R. ~ ~ B~uK~~ ~~CE 1b~ i ~ ~ , ~ - . ,r . xr ~ ,~^7..y 3:i~~ya~~- ~ s~ - ~ 'µ.~~1~~ ~~~2a.~~ : i~ . _ _ - _ ;3" . _ - , _ .