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HomeMy WebLinkAbout0811 4,~~r:~ ~ ~ 4. . Ii1~~ln011an l~ - - . • , , 5"i'ATE UF F I.~RIDA ~ ! ~~~G~ s ~i 6 ~ DEPARTMEN7' OF R.re+. ov n.t..., cow~ao. Health & Rehabilitative Services: DlSTRICT ELEVEN L~ADE COUNTY DEPARTMEIvT OF RBBY CERTZFY ~4lIS 'PO BB 11 TRUB COPY P~sLIC HEAI.TN ~~Tf~E' ~~OCl?L RBGISTRAR'S RECORD OF 1350 N. W. I~TH ST. S - r~~•'''' ~~u MIAMI. Fl.OR1DA ~3125 ' a~ ~9 ~ ~ ~ . ~ E' ~ " . ! f~ ING : ~ ~ ; % x,• r, valfd unlesa the raised ~ i ~ ~ ~ L" ~~1.' of the Sureau of Vital DEPLTTY REGISTWIR ~ '~R~tistics is affixed.) VITAL R~CORD6 UNIT t - : i ' ' r~tv~ _ ~ - . ' _ " ' . i s~at~otf}~~~R~ ~ CERTIFICATE OF DEATH . ~~:n~ent u[ Health an~~R ~13~6tativc SPhIMS ~'TAT[ ~~~t t+o.. - - ~•tTa[. sraT~s~rtcs _ F L O A I D A pE~,sT„~~ ,.,0 118~~ ^lCt~:tD--"~aMf DAIlO~OI~TM ~c»,• o.• •e•~• John Nerman Mderson MALE SEPTEMBER 8, 19Z8 _ e~CE w~w: ..4... iGt - :.~r ..o~~ ~ *~~.oe~ : e.. C E 01 ~inM . ~ ~ o.. +,CO~x+tt O~ DI~*„ i'. ~ 1?~(:~• ~~~iwJ~• •~~~1• ~Ol 0~.: wWN1 } ~M i = White ~_lsa f+5 , ~u, ~s~ _i__ ;s Au~• 24L1913 ir, Dade _ t~~• ~Cwt~ Of tC~fw`~^N OF D~~~N ~.o~ :~ni+.~ri ?IOSMI.I O! OTMEf NS ITUT~OI. N~M~ :.o. ~:.e va~~ ..o +v.•~e~ ~ ,~s w ..o Miami ves ,~~~QK MEMORlAL HOSPITAL - - - S~aiE O~ WTH • .r~ iCiTilfN pr wN~i COU~+i~v ; MA~RHO N[K~ M~.ttrED SWYIVM".7 SrOuSE o.e ...w......~ . ca+..n.. vv100W[0 EO vec _ ~ India~a USA _ 1,,, Nido~w-~e~ _ _ _ _ ~ ~r (i~. S!C R~t~ nrurU~f VSuat (YCU?~teO~a c.~ a..o e. oo..~ o:~..+~ .ov c. awD O+ WS~+ESS OR u+DUSTtr ~ i CY•~K ~ t.~•• ~f' ~M • 7J.5-~6-2856 ~Owner ~ ~ New~ A encq -g-. ~tS~Dtr~C! -S°~rt FCOurvtr - - ~~+t~. ?Oww tK tCY~T~C:?. - - j ,•~w c.n ~ras ~STHlT ~u~/0 NU~[~ - . ~r~c~~• •1s W +O ~i Florida Dade i.,, Miami no 530 i~ W 119 St. ~~iHE~ ~ tiati.f n~u ..~;,o;~ uV i MO1MEf M/11p{N N~MI ~~tu r,~p~ ur . _ . ' ~ John N. Mderson ~ Anna Listen ~NtORMwHt -Nw:M! Mw~r+G wOGtESS o... o ro . c... o. ~o~.-. ~..n. ir~ Carol ~ane Mderson!~+'~rthmann i,.~, 2433 ~'en~bly Lane Trov, uichiRan 4808L = ui 1 Q~~M WAS CAUSI~ ~t j(N1fR Or'rl? U?~E CAUSF I[! iMf iOf te~. :e/, wr+C ieii Mr.~u.. o«sn •w ~e•m - _ wre~.v curat ~ ~a; OVERWHEIM 1~1G SEPT 1 CEM IA SECONDARY TO NECROI i Z 1 NG FASC IT St_____ ~ 6W'7~'~i . . 6..Ti -a,t..~, 2~T-~_ _ cowe•no«s. .~~cw c..~ uu ro ~ 1?1 - - - - C~Yl~".~: ~ h+~ ~O. J~ ~f ~ COw1tO.Mw(t O~ _ _ _ _ _ _ _ " ' _ _ " - _ ~ ft~t.wp ~w/ yw0~~ ~tIM6 C~YN ~~11 ~ , ,o, ~wVtO?Sr K tifS ~t~~ .~.e~«ms cor~ ?~tf t~ OInE~ fK;~+tiK~Wt CONO~T~C~S co~.:.~.o»ti c: ~.n~.~un.w •o w.r. ~v. «u• n~veo •o u_ . -~-T--- - I ' ~..f o~ wo ~ bM~N w w~u.~•.~r4 uvM ~ o~aBETES ~ ; f - - ----------~,-ves Yes : t ~•.~~i •CC.olvt. Su~CWt O~ A~~IN/il~' ,..o.~.. w• .e.~ • HOII! MOw' ~~alu~r OCiU~~FD ~ ...ruw w •...v~. . p~ r.~i n~~ ~s : M.r~~l ! .]i tr~OtTIWWEO ~ 1 F tY+a M - ~ ~ i - ~ M ~~-y'-- - ~ f ~NAI!• w/ wORR K~CE d~?+~ee ..n~ ..~r s~w~~. r.r+w.. IOCAf10N ~n~r o~ ~ r n r., c~'• o~ r:..w a~.n ~ ~ . 1Mt~n •~f O~ r0• IpMKf NDG .~K . VK~n c ~ ~ itrtnKwTK~a-- ..a. ~ C.• r~~~ ~ ~Owm D~r .~.o ~s~ i•+ ~n C~ .:.~c'a~0 ~O~ •~fr rw1 DtAtN IXCYMlO .r M~.KI. O. ny ~ ~nt~K//~N TO . K•••w 0~• R~~ ~~UDr ~~If~Of~tw .,py~~ a.n. •«D. q M Nf~~ c ~~R~wCfO 'wF ~ CI /r~D~UOGf. OY~ t E o~~~..fo `I"' --SEP7. 13~fl 1_~- _SEPI~. $ 1~~~ _L~, ~n _ r~3 OA ~o .w ~ - . ~E~'dKwt~+ ~?~ED' l~ N ! E~ a+ ~.s:~ r.r -.o~ c~ c..... ~•e ~a~ * .~o~.w«c:e o~.o ~,..~...r.y. e~ •~n ?x• o•J~,M , .~uw..~K,.. o....-.o.. ..o.iry w. +c.. ? M[~~~~[ i?e o.~~ wO Ow K'+~ C~ju 3~. t•.rlc . M ~ :1=. ~ ~ M ( . _ ~ _ _ ' ' ' . • CttiifiE~- v4A.E ~r..e ~..r.~•~ ~ SK,H~tW~- . . ' - - ~ec.n~ c. ~~a,~. -~b~TE SH'1?~!D ~.r,».~ s.• nu. BAILY M,_ D ~ - ~Hl~.t~-_ i ,t.:~ ~?~Y ri.~ ~~1~8~ ~478 - . MA1lMi~l A~afSS - f i ):N!• ~ 1 f wQ . _ . ~1 •prr i~~h ~I 1 11 N W lJRU~I Ct~w•fOr+ efMO~~~ ,CEM[rE~r O~ CRfMATO~t__ni~wf ~~0: •'~::n c~•• oa +c~•_ ~~.v ~ M . Floriaa. • CreQ~ation Van Arsdel C,re~atorv iami , ~ ;.~•t r.-. r.. •w. ~~i r..t~~: +~OM[ '.avt •r.^ ailC~(S~ ti.~e~• o. o .o ~ o~ +n... r..~ ~~;r.- ~ - Sept __ll, 1978 ~:-~Van Orsdel Grati nv Road Chape1.77~J t4.Sd. 119 St. Miami, Fla. •tr~~~ O•~E(1Gt- 5~<.wr~r[ RiG~St SiGv~nrq 'O~rt ~lCE~~~r~c,~~ • c..•q ~ i t ~ [ : .fa ~ . i ~ ~ ~ ~ ' ~ ~ ~ ~CO~: ~D , ~ ; J': `v r= . ~ - ; - : - ~ 43~03b~ 7a ~ }!N t+~.r ~ . ~ • ~ ~ • ~ - _ r " ' - . . ~ ~~'Jr W~ ~7~~ ~ _ - - - - - - . - ~ ~ ~ ~ _ . " - . -