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HomeMy WebLinkAbout0871 4~7~ % ~ ~ CERTI~ICA::~ Or DEATH ~AT~ .~L~ No. - • - Ik~r(Imew1 ~ ~ev~lh and ~:~{.+l..~uwH~e V ~var~ ~ ` ~ r ' Ill\N(~\ ~N ili \I111 S:a ~~t a a`~ A Nl'G167RAR'S NO v~ A1YY M'INY II~~~~ ~ . ?:.A' IN a~w, 0~~, ~i•~ ~ ..~c.~ .,sc iSEt 'Dw1E O? Ut~in ~ -o iw oect.sco-.+M•e A,~c~c'2~ 6, 1976 ~ ;.,,:~a~ , . G~RGE T:~:~ :iale ~y»at~ ~ ry.~ ~^.u ~ e.. Cw.f W~IAir1 ~•ow~w. o~~. ~Ca1HTY Of OEniH tA~~ v~.t1. ~~4N. Y~IK~w ~MirM. A~if~~~\I T~~~' ~I~a ~ uc. ~ ~nt~~ ~ ~~n.o.~ ~n~~u roti. ~.q wwa ~ 3]. i 1901 ~111 ttihi.te 75 w. I ' Oc~' ~ n.uea , nOShlwl pA O~n-R ~vST~TyT -N ~r N~ w am~~, 4M f~41/ My MWN~ ~ CITl, tOwN. O~ IOG~T~On-bt OEAiM • vat u ` 11fCMf O~ MO ~ . _ Yes ~i.rtin :z-:x>rial tlospital St113..'~ ~______._---r--------------- ~'^,SYtvrvr.GS?OUSE~,••••~.on~...w•.ww~ . r..~~Gii1tH W Wnwl C01i?+S4Y n~.a:.iD. VA~)'.FD, . SIASE O~ Y:iiM ~M wW w O.f ~W~i/~N[D. '1'F..%.:ia ~VKJ~~ • CW~~ ~w..,~,i .~A A.~ ~ ~ . : r~~, ~ , ~nr,sylvania ~ _ - -~•:e' ~ Sxcw? SiCui~iY nw~?ta USVwi OCCuiwTAn ~w~n a..o o~ •a.a ec•.~ w?y.e a 4tw0 OI WSwfii O~ u+DUS~ir ~.wa..o ~w. nw M u~•¦u ~ ~ ` L'ic.~L'.rC:I' . j ~ ~ Bt1S1riE:SS ?i1C.'1L'1@ ?7dri _ u i$2-OS-OSll Sial~.s: ail '~....w .,,.-n ~ssiici ~no i~J++NEt . ~ .iroM t ~ - GiV, TOWr.t. Ot ~OCwi~Or. . • - . P(S~GihGE-S/A~f ~GOUNZY ~11~1CM~ W 1-0N , ~ 'rbrt Pierca ! :~b 8907 S. In3ian Rivt:r tr_-. r^~orida ~ St. Lucie rwa ..s~ ~wO1MER-A4iOfN N~M[ ~u1+ r~1 rwt~ua-ruMt ~w~ F~ward Eranu~l ~c: ~i? ~ Clara Stec:.el ~MA:~t?:G /w:.iiSS ~sU1U O~ ~J w0.. (N~ p w~n., H.n. tr~ . .~r~F{~~MA.vi-NAMf . ~ . Knall S9Q7 S. Z~ia~ R.iver Dr. F`c. Pierce, r^i 33~~C A]xsa S. 1~» = . ;trtiEi WuY G++E~C~.iSE tf~ i:~tF EOt (~l t?1 (Ui ~~~r.•~~.. e_ s~_! _•-•c u.~. + ~Nt DEwn~ wwS CwuSEO ~r~ t ; u rww w/u ~'1 c~ ' C.~/` C_i~v Mii7~ ~ ~S- ~ _ ~~~fl ~TA~ ~ i•? ~ . ~ ~ ~ <o~~,,.o~,. ~ y4 ~ 'C AS 'C ; ~ ~ - c A ~ c. ; ~ ~ M,~ . e P, ~ sz T~; ~ . - ~ ..~~c« o..~ uu w~ i?1 ~ ' - ....~o,n~ c~W~ •or, M W. a~s ~ OOr.1~Ow~iu O~: . - ~ . ~ i,.n.c ,.e Y/~O~t . ~t~r4 C~VN ~il i - 1~~ . ~ wUtWSY ~ Y!3 v~ai .w~..c. cc. i ?w4i Y. OinEi SK.++JiCN+T COwWT~O?~S~ co~uo~~ canw~~wa q a... P+i w01 ~~YTI~ 10 L~YN 4W~M M~ ~Vl l~~a w••o. ~ s,wno ~~~u.~«~..a u.s~ i o. o~.~• ~ - • ~,.J~ y ~ ~ ,a ; ~ v ~ - ~ ~ L M A - Y• 1~~I~ ~MY G lM/Y~t ~M I~N ~ O~ I~~t N~ n~Y 1~ ~ ? ~•~-.'.,i.o! A~U~INi. YfK.3t A ~~Ow1w.M7,~u~/ ~M~NR MOW ~N1Ut11 OGCYRtfO ~ ~ r4•.~.L.~ 01111+JtItiMlhiJ i ~ ' ' yiA ir~: Ji'r wT wOU hACE Ot wlullf ~o+t. fuin, ~.n~~. i?O~'wbOn ~ uun w~..~. .o., c.n o~ ~or.., ~~n~ ~ 1 ~•M 1 ~ ~ . ?nan m o~ .a ~ ~oNKI MO4.. ~R- 1 VKV~ ~ ~ _ 47M , . M'OI~Tw OCCY~~ID .r r.~ nr.c~. O~• 1 M O~~ 1l~¦ ~~N •~S' f~~r w:r/M~ at~•l O~ Ob/W~A ~ ~ t'F.7YtUT~ON- rO~~~w Mt q~t ~ ~W~ . ..ori~ tl•~ ~00~ IiP N•a.. ~~nO~u ..rt. • : ` ~ /Ni1K~-N: / ~1 _ ^ ~ TO ~ Gr ~.v~+~ItK-'. ` . , t..~,~o,», ~ / rz - ~ - ?~G ~z~~- ~ ~ - ~ - 7~ ~~,.3-3:~4. : ..~L r~. a~c,..~~ ,.o.. r(iO ! Jl:~ i . ~ - 1 ~ ~ ~~'/Wnf r~1 f~OwO?wC~~ Cl~~ r,~, wOr• . - . Ci~S11GiKlN-MFD:CAi [XAMw~IE! OR COiOhEa~. Or twt ~•SN W tw~ ~WY~ O~ W~cw ~,pNtw ~ It~r~r.~~y. 0/ i~! sCDf ~+O/O/ ~~l :MISh0~1~6M, Iw Y\ WwWw. ' ' w c1.•. oCCWYO O~+ Ml O~tl u~0 ?M W iM 4W~aA 1~~110. N.' )1? . ' rr.tw. t a~(;.~.wi~iE aan~ w^jn+j~e Owtf S,G~E~ ~ ry,. y- ~ Cciil/~~'-iv4Mf inn Oi r~r. ~ ' . ~~Yi/~~.~L • j ! ?t:. f L ~ ~ r ~ . ~I`?!/' t~ l~1 ~"L~-- /~r, .i p.r-'a ••iI .A ~ c~n o~ ~O...a s1.r~ t.. f ;.~.,Y.a.,ooaeu ~t ~rr+~• ~ ` /1 % , t - -1--- 1] /~y~ Q / ' 3 i~ s~ ~~.s .~J ~i ' r! G~~ f/ ~ il«ATi~~ 4n G~ q.r 1r•n` /i::R:ti. CRiMAT~ON. r~cMo'4~t ~C~:alr OR ~cHtAiO4Y-~~w~uF C yQ~1C.a ( _ Ft Pierce Cr~atoriu~~:~. • Fort.Pierce, _ GYa~~ation • j _ ~y~~,.. o. ~ OA7f I O~'~ o~' qv -~--;fU?+Eiw? nGmf-~~~•~t ~r~~ ~D.-,:[=S '~~1' O~ ~~C 4.• ni~~, Floriaa 334~V LL $ 1976: Yutes F1s:..~.«1 "t:c.:~. : o-r. 777, r ' ,:w 1~_•^.CE'~TiQC'.r ~ ts. _ own nct~•~o jr ?c+~ : ri~~s:u¦ i ~j. y aiG~Sia~:-= i,..!..r~4i.~3~ J~,~~~j) ( 1^ : ..i.1ti.: fuw[r~~?:~c~:O~//• f~~ . Y lY J. /i-=rP /r~.iC~ !~f E n. r. iY74 :1e ~ 71- .~C ~ . T hereby certify t:~is to be a true and correct E copy of the Local Registrar's record on fil~ in . ~ • the Martin County Health Department in Stuart, ~ 4 Florida. 3 . . . ~ ' . . • ' yl=y;~4i _ rc. _ • • . ~"r .(Warning : .~ot valid unless raised seal of t~~e _ '~,`~~.~.~.;?~t ~i(I ",:ft. ; ~ - Martin County Heaitn Department is affixed. ) . t~= '.r ~ . , ~j ~ Archi~ ~icCallister, M.D. ~ ~ - - County Health Oificer & Loca], Registrar _ ~ ~ . : - . : ~ ~ F . 'p~ . - ~ _ ~ ' , . . . . . : ~ , +j ~ j , / 4~ ~it j. ' ~ ` s,~ ~ ,~s ~ _ _ ` Date cal egistra ~ ~ - - ~ ~ ~ ~ . ; ~ • - ~ • ~ ; ~ £ r; ~ ~ . I ~ _ , ~co~oEO, ~ r - f. F ~ ~ ~ - ~ . ' L:,. ~ . .4.~?A'73 ~ 'i~ 26 R~~ 3: Z p ~ ~ , ~ ' . i~~ 3U2 U~ ~ ~ BC~ ~ r~ , ~"1 ~ ~ . ~ 'i ~ ~ ~ . _ . a ,