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HomeMy WebLinkAbout0541 - ' 431855 ~ Sta~~•otf1~?riaa CERT1~ ICATE OF DEATH Ik~parl~mnl of Il~al~h and Itchabililrtivc 5~•rricca _ - sTwTC fILE no _ , vrrn~. ~'rn'rlti ru~s F L O A I D A . nrf.~6inwn S NO OlCt~~ED-~a/w! rw~~ Sta U~~! W M~tN ..u.... TvPE OR VHINT ' ~N , Thco~iore Jolui hnr;ru'f't;lt ~ ~l.-?lc , Uccembcr b, 1 N7H PERMANENT - - - - - fiLACK INK ~~~E "~~w. ..~~K.r W.N~ •G[- ~•u v..or~ ~ u~ ~v.c~~~ . -,11 C~rE d WtN ..a.•.. COtJ?+tr O~ Ot~Th 1K ~ 1r~C~~r ~ ' •~~~..0•• . r~~~l~ +Of ~~~f ~ W~~~ M ~ . whitc ~~_73 se~ 1;R Pl.ir. 2.3 ~ 1~)US ~ 13row~~rd 'II C~r. ~OMRI. O~ LOCAl10N O/ QEAIN ~+ue~ t~~ ~rn'1 NQSMT~1 O~ OIN(t NSf1iU1qN-N~W( .w• W 1~~~~• 4~t f~wn ~w ~w~u~. YI(N t~f W MO I'lantation Ycs „ IZennett Conununity Ilospital ti * • - Si~tE d WiH .r ..or w v~.,~••~ CliitEri W ww~t COUNIt~ MAf~~p ~V(f M~\f1EO. SINYIVMK S~OIISE c..~ ..av~ . ` coM.w, . w wE . W+O~ O~ vu+• ~ ~r,..,~..«. ,New York 4 U.S.A.- ,o~ic~owec~ Aone e.~~.w. - .•.~o soe~.i set•rinr ~xw~e~ uswi oeev?anpa ~a.i o~ ~o.~-:o.n a»;.w •oe~ o. cr+o w ww+fss o~ ~?ausrr: o,.~..u r •w.~..a n.~.eo ~ . 06Q-03-4183 L'lectrician ConsLructiun .n•or»ca wroa - '.:~.-o~ a+: ~~-•es SuEEi ua0 NUr~Et° - ~tSWE?+CE-SiiiE COU~+tr Cm, rowN. oa toc~t~o?+ ,~•~c~• •n o~ ~.o ~ . L..~~ ~~i~'IOI'11~T ~~e St: j.UC1P ~ ~'t'.. ~~1CI`GC e~e ~U i~e flox S ~Zt.. ~7S • k IwiNt~-?+u~.[ .uf• rax~ ~,f, ~+Or~t-wurDf?a ?~u~V r.~f~ ~•wa~ ..s• Joh~~ - 1'aul KAL-'"tI'['!;R ~i:~ry Itosl'c1J ~wOW/WT-wuwE ~ ruRwG w06tESS ~su~~. c• ~~••+o . ur. p~ p~r, f~~p. tr~ ~ ,,,Ttr. RoherL Kaem~~ter 1 930 S.W. 7U :1ve. Pl:iiit.ltior~~ 1'Ia: 33 :1 ; . • ?~n ~ . DE~1N w~S UuStO ~r ~[?+tt~ Ow? oHE t4uit ~Et ~wt ~ot t.?. iel. ~No ~.q ..=a~ o.w ..r w• rr~..n ew~e . N~ V Q N. • ~ ~ • ? MSIOV~~t~ ~OrO~I~Or7. •r~, . ~w.cr G~~! uf~ ~O (`I - ~rr~OUtf l~w~ ~o; W~ /O. O~ ~f ~ CO~HOWMCI O~. ~ _ _ . l~~IIMG t/! VM~~~- " ~.~«s a~u ~.u 1~? - ?ARi ¦ OiME~ SIGMYK/wi COr~W1~OnS: ca+M~o.n coM~w..w w N~~. ~w .a~ ~~u.~s ro c.rr» c..~.. ~.n ~ w ~UTO~Ss b tEi ~~n ....~.~c~ tc . ~ qf p~ rp~ YN~~O N4~rrw0 4a ~ ~l) W ~f~~~ ji.si~..e 1 ~CC~O[Nt. SUK~OE W ~T~~r~J~1~ ~.a.r., ~.~..u~~ MOW Ir~lU~r OCCUUEO ~~~r~••••rva a~~w~. .ur . o~ r, .ri. NOr~C~~: Ot {MOI~tU+~uHD ~ (~~1 ~vx , n, M 7!W .r _ ' pilutv wOR[ nwCE O~ r+x~r .ow. s.n~~, ~.c~a.. ~Of~t~Or+ ~ ~,•u• o~ ~.•.•o . an o~ +o~... s,.a ~ f ~ ~tACtI~ qf O~ «O~ pnK/ MK..~K ~YKM+~ . ~ X`~ . ~ . . : ~0 _ ~ M CtttirK~t~pt~- ro.rw w• a.~ rorw. o.. ...o ~.s. u,. «:.r.~~ w~ oro;O~o ~.o• w o~~~M o[cu~no •~i o.••. ?M1SKI~N~ r0`~t~ O~• r1?~ ~ ~t1~~ N~'~ w(y~~ 0~4 ~~A ~O ~ p ~p ~ A~fIMO~O tM/ ^ ~ {I 1U ~b :)1(I ~ I) a ¦~o,..~w~ ~ 7ra o~c~.s~o .w. ~ I • V V O ~,e ~ 2 ~ ~ s ~ c r. : a 3 M.o ~ ~ceirK•~~o:+-woKwi ~iw~.w[. oe ~oror+Ee w n.~ ~.a.i w u~ .ov~ a w.n. ~w~ ~~cia.. .~oa.o-.~~e i~:• ~[~~W~~~~ d ti~ ~00~ ~M(~~ N~ W~/S~K~~I~OY, ~M rt ~~M~~. . ~~M ~~I b11~ ; ~ ~ O~~M p(t4~~H Ow M 0~~~ ~w0 OM ~O ~M (~Vft~fl )~~MO . S 12s _ ~ M 770 _ ~ CE~ilfl(II-~+AMf ~n?t o~ ~~wa S1(3NA11i~E oec~v w r.n1 OAtE SK,?+t0 y~ qu. ~ ~ ~I.CCL.`.~ t~ ~ er~ f~ _ ~~~x l Z ~ wull ~OD~ESS-Cf~tp~f• n o~ e..o r.•. c~ ~4.. ~~•n ~.t ~ .~ps ra..~ s+r. 7~~ 739n S~LIi SL. Pl~nt,.~Lion Fla. Mar +9n. ~w? ~U~~AI. CfEMAtION. ~EMOYAI EMEtt~lt W C~E~MiOwt-?v~~+E tOCwt~ c~n c..o~•. s+.v c~+:~s OoCVS ~snc~n. ~~•,~„y.,,, ~ , ~ti~~mi i'lorida ttemoyal ?~~Gi~ove_ Par_k Crcmator} --pi-antatiarr--~`ta Ow1E ~..o..r+. e... iu?~fll~l MOME -•~wiu[ ut0 ~D(HISS s,~~n o. e»n . c~.• m?ov.»-s+~~i~ ~~t f - Uc~ ~cr 8~ •97 ~.Pt.t:al lr- 1'lant<<ti_~,n~Funeral tI ip~ '~tt~IHCU~P.t1~ tl~ 5t. ~ ~ IWi~~'/r~~-pW+~tU ~ G~St •R ~S~G?+~IU~F/- ( / ' - o..rt ~e s ~ ~M M~ea~s~~.• T6. T ~ ~ ~Ii f~ Vi. ~ L ~E..ty • / ~ ~ 7 'I ~ ~ , ' ' ~ , ~ . , , , ~ '1~ . [ ~ f~i. . . _ ~ ~ 9 i8 n 431855 9d~ ~ . ~ ' - CERTf Ff ]iO CUI'Y " ' - ' ~ ~ ' : . ~ I hereby :p~t~.fy ta~e above to be a true and correct copy of tiie I,ocal Registrar's ~ a ~ t " i,~cor,d oa -$i;Y~'•~t~, the proward County Health DepaCtment at Fort Lauderdale, Florida. . _ .y_~L' (Warning-N ~,~v~li~'unl~ss.raised seai of t~e Br~••ard ntti• 17_alth t. is affixed.) :~~.t - - ~ ~ 4 ~ ' i~'!'l`~ ~y~ ~ 1-16-79":,.'' oL~ . _ ~ . , Co~~nty lieal(h O ticer and Local Registrar ~ ' ~ ~.~GG~c-j'z. ~.0 I ~ ° R 3U2 - 5~1 - ; ~ - ~ bC'GK ~:~;F Chief eput~ Local Kegi trar _ ~ ~ ~ ~ , ~ e _ _ . ~ _ _ ~ -