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HomeMy WebLinkAbout0182 ~ ~ ( . `~c. p7560~ : . ~ IN THE CIRCUIT COURT FOR IN RE: THE ESTATE OF ) VOLUSIA COUNTY, FLORIDA SCOTTY H. ANDE~~ a 4~ 1~N ~~p'ROBATE DIVISION ' ) . ~ DECEASED. i~;. ~7 '~t~?~ CASE NUMBER 78-463-Q2H . . ?i •t' : ~ • r`•-:: -".UNTf.~a+`~ 1 VCII'+•r ~ ; . • . - , i State o[ Florida CERTIFICATE OF' DEATH ; Departraent of Health and Rehabilitati~e Services sirwTE F~~c Ko.^,_ 's ~ V1TAL STA~'1ST1CS F L O R I D A RtGItTRAR•f NO T YPE OR PHINT ~Ew3Ep-H~w[ ~~y+ .'a~'~ ~.s~ ~x D~tE W DtwTM ~ ~o..~., .e.~ ~ PERMANENT Scott~ H. Andorson ~'oma~p , I•'~arch 14, lg~g BLACK~K RAC! .rp. wf6q...~Mt..~ AGE-us~ ws~~ ~ n.. ww~ ~ w. CwTE Of NRM ~.wr.. COINatY Oi OEwiM ~ ~~1lTlt4 aa~~ ~•aa~ - .os wn wows _ • ~ ~ v ~ k ~9'an 29, 1914 Volusia _ ~ CIIY,101Ml. Of l pEATM ra~ cw~ ~r.*~ NpS/ITI?~ q OT11ER NSTIt rp w ~~M~, 4M f~N~t ar~ rwWt 1 snc s a «o Orango City s 360 S. Carp~ntpr STATf d~N1N ~w ~pr r r~~r~ CIi12EN Oi WM1?1 (qR(1l11 IM/~~RIEO, NEVER MARtlEO. SN~vIVWG S~OUSE ~r ~Nl. OM ~uNn ~+y ~ ~,~-..~,a.« , Indiana , USA N~ow~~,•"`•., ~ .n~ OK~~1f~ ,"io u a.a~ SOCUI SENtlf11 MW~E! USNAI OCN?w1~Ow ~aa o..ou w+e wa.w .os+ a ~cwO W WSwtsS OR o+D~Srett °`s°w~ 292-24-1542 "°~fiipa"Z."'orr~svolldont-Ch ~stian Sci~nco ~Church • ~ILDf~C! ~f~OM ~ . •D"~"~"' tE SjA COU CITy. iOvvN. O~ LOCAf10N ~+~w c~n ir.n SI~EEi AND NVM1E! ; ~~oric~a ~olusi~s Orzna~ Cit~~ ""`"'1T8'"° 1800 E. Gravss 4vA. ; IM - 14 ' 16 - - N~ Iw fAT/KR-NAA~ " ~KN r~00~~ ~ uft MOTME!-/IMrO[N NAMI ~MSt r.OM~ Ws~ ' ~s Scott ' ~ Hankins Effi~ ~howning i 1?~MO~~NT-wAM! rulwG wOG~ESS n.nv o. ..o. cm o~ wv.., s~.n. tr~ ~ ~ric C. And~ rson ,n 41 S S. PlPasant St Hinaham, ;i3ss ~ rntt otwtM wni G?uSED ~T: ~tNtEt wvtr WaE C~uSE H~ ir+E Ior hl fa! ~ k~ NA~ p p~Hl ~M N~f( y wro~.w uww ~ Acute viral infection . . . . ~ . co.wno..s. u ..w, ~ . ~wK» 6~t1 ~~f! q ~.r~a~n c.rs~ w, w~ w. o~ ~s ~ co~.searr..te o~: •t~urp tq ~wN~- ~ pup t~~at 4?st ~ ~ ~ kl ~ 1w~T OTME~ 51GMIfKwNi COWD1ilONS: towawws cor~wur~.w w esnn. w~ no+ ~euns w c~rs~ c~+er r. ..n ~ N. wtROKr Ir 1IES VU~ IIM~IMO> COR' ~ t~f ~01 MM~N ~ Nt~lr~wwG 4v~ Pulmonary tuberculo~is, arrested ~ lefo ~«•~•~M M V~?t~ KGDEM A ~.p..n, rtu MOt!! NOW INJ1ltT OCCU~RED ~~M~~~ ~~~n a~~wn ~M IU~ ~ a~~t~ M~ nrr ~ - I' qOM__ _K~p[: O~ YND~IEWMtO , . i (1J {~~O,M . ~ 7w IU M )01 ,'Q~ ~ INJURt AT w0l1( /LA[E Oi IN/1JR~ .e »ar. r.~~. s,wn, r.c+on. lOCwhON ~ sn~a w~.~ o..o , c.n o~ rw+.~. s.•+e ~ Q ~fMCV'1 M~+OI pNKj MO(i.,lK. If~K~1?1 ~ ! n' 7b. 7M 1~ ~ CEti~iKwT~Oti- .aww nM .o..w e,. .w - w.w us~ s... wriw~~ u~.e a+ ~ oe~sw w. ..a~ ..w p~~TM octvnto e.~ euc~. w w. ?wrfKw~: 1O ..o..w. nu wo. .nn a.+w ..w~ ~ w.n. ..e, w+re ua ~ •m.~w~ nN a aw.n~ew. et" y~ 7~~ Nu.uo.~w. ~N t~ tl. r~ ~o nw c.ws~q~ s~.nc ~ GERi1fKA~~ON-MEdUI EIwMx~IE~ OR CORONE~ o» n.e wn a nn „a,. a~•~„ u.e o~c~ ..s ~o w.o p ~..r....o.. a ,,...o...»,a .,....w..,o,.. a..b... App . : 4 S ar 1 ' '9 7~$~~ "~'b - 4 SA E ~t•w. occwre w w.~ ~.~e w~ ~o se uvsen~ i.•n~ ~ E~ m f.ERT ~m~ S~GN ww~ ~wu ~ wr.~w~ : ~rt~iur ~chwart z ; M : D . / ` ~ `~~q ="7'$' ~ y"`'t°0 hBtY~`~ Annex, Room 5~03" D ona Bea~h°','°Plorid - 2_ ~ ' ~UMAI. CREUU?TION. ~EMOvwI [~tETERY O~ CRiMnTORr-r~w~ tOCwnON ~ un a p.... s~.p ~ ~""~rPmation ~iid-Florida Cr~mator~~ ~ Ik~Land Florida ~ ~ ~ ~ CA(E ~ M~ RAl MO N~w~F ? ~ SS ~ r •.r.• ~tr ~.t w s ur ~ • ~ „J'f3rch Y°~"; 1'"g78 y_ ~n-~umm~r~i~, 1~~ V°o~us~i~,' ~`~anr~ City, Fla ~ ` v_5.1:612 ftlNfRA OiREC?~J ~ ~ ~ y' ` ~GISt~- (~iNAIURE / ~ O~tt f1 JrfO ~i l Al ~tG~S~t4f y Rev.7/76 iYLt~' l~. 1~ ~ ~ ~ ~ . F CERTIFZED COPY ` ~ 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 ~ . • .i.:C,o~nty Health ; artment is affixed. ) ~ ~ ~ ~ : ~ ; ~ . ~ ~ • ~ •fl~~ 18z ~ ~ , . . . ; S = i, • , g,;~ ~ t i-: i ~J County Health Of ce Local Reqistrar ~ pI,' l~ :j1'' . I' ~ ~ ~i ~r2~~ ` ~ ' . n~~te: '±~rti~ Local Deputy Registrar ~ .~,,~~ti-~~s~.~` - - --.s..~~_. _ _