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state of Florid! CERTIFICATE OF DEATH
~lpertTTltDt Oi' H!lith !nd RlhabiileEdiTrs Services RAT[ ?llt NO ,
VITAL. STATISTICS F L O A I D 1l -
N[OI~IfAR ! RO
TY?E OR PRINT OKEASED-NAME. •,tf' rw.t uft ,SER DATE W REAM • r4w•. C+• .•a
PERMANENT ~1
~b_ert •.____Boatwri ht Sr~Male ~ December '1978
BLACK INK RACE awrlf ..tGiO. arfolC.w awe.ar. AGE -a.fi w.olt ..u.~w+e~it , o.. CAfE NtrM ..ber, ea., COwtr Ot ti(A!?+
lac r wcn. ,y,.e.• •ieuf• rOS - i 'e:.i '-wowi ~ wa,
_ B_laoY 4g s< Dec.5 1 2 St Lucie _
WOZ CITr TOWN OR tOCA11~N ATM «aUet tw ate.n MOSNIAI OR O1NER !!ST - .r tr0/ w t.Mt. o~w ftt,l• ..w r•~.t/t •
wcwt .tf a wo
Fort Pieros ir___Yee _ ,a____DOi? T,~awnwood Medical Center
SLAT!
OE WM .r rei rw r f • . «arf ITIrEN OE v11MAT COtiNrir MAtRg1~ElDt. N[Y[t MAgMIEO. SSUtvwt~iG SE'OUSE ui req. 4.•t. r.u•... rt•
cel/win, w° Aarr ea'wc..., :
ofWa N,MrC~ . ~ Florida ~ . - II.S.A. ,o Ellen Fuller
~ratweect.fis - - - - - - -
.•.to « e,e/w sOC1At SEC'1wTY NUWER VSUAL OCC1MA1fON .Vw u..e of .Ota eo.a o,lu++G woft w KND O• ENSIfIEii p tNpVSttc
occaws .oN«w aW, Fl.. « N•.tN 1 .
t? 253 42 7866 _ Sheriff Count~_
.rr.ssa. tEStDENCE -S1A/t COUNTT' CITt. TOwN, C1R ICtCAt10N rtNt cat arawf TST~EEt ANO NtHitt~
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. - Florida Tb St.Luoie Tk Fort Pierce ,.e Yes ,a 01 Ave. I
EAIMER -NAME nyt r.oetl - ,.?fi AtOTt1Et-AV1fDEN NAM( t.qr nowt ua•
Ma Emma Boatwri h
~ I WOtMANT-NAME MA\If~ ADDRESS IftMq a t t e wp . let Ot ros.., u•7, tr
•t. Ellen Boatxri ht „e 3301 Ave. I Fort Pierce,Fla. 35450.
?ART f M OtA1M wws CATKED [lr. _ t[NTEi ONIr oNE CA{IfE ETit tt+t tOR NL lel AHO tcp _ ;N : ~:;t• ;
.a ww ; -
COwM,Orf. M Awe. ~ { _ ~
aew,ew Oast NN q IR) ~VNMN`
Iwre.at ta,lft rM, eM q. Oe Af a COwStOY1iK~
OtOr !_^._~y _ _ _ - _
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at.w0 CAIN uft
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~ ?ARt • OTwEt S1C.?IrtKANT CONDITIONS' tpwpn0«a COntyv/.rG q Maw aaM .rpt Mu.fe a0 t.YN Gratw IYt r .,r
i , N{ pt «p. YNtfO r=N'ftr•+^ 4 C
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W 7'00 ~ - Iri M ?>•7
IN1Wt Ai wORR MACE OE t~UUfi' .i wort. r.er. futa...caosi. tOCAl1C>!t . snot o.. r e wo . c.n M to.w, u.n • -
j ,wan n f oe wo, owls a,a . es .span r
708 7p. - 700
CEttiKATgN- - rotnw w. rw ~ .rowM e.. .w .are uft f.a• w..i+n....+e Ow . eniae wot .Mr 1.. eEA•w occwno ..t t tr.. r"•"'
/w~fK1aM tp - .aerM Mt ttY We7 Awttee.ill .wGUtr t.n .+s w'
..mwete rA{ 8-05 w .w...,r.t .
7•A M(i.N. t.o.. 9 20 78 Ire 12-3-78 r. 10 20 78 did no 7:. r ,o c...te
CE~TIIKATION-MEOKAt EIAMINER Ot CORONER ow rwf wn or ,wt rw,w a Now iM M(faw+ ..f NOaOV..Cie a.o
tttr~.aT.O•. O. tM {OOi .M~Oa ilrl w.vtftwat,p.., .w /at ohuw0.. ~ rp.b Me K.t wfwt
O/.iw «(wN. w M MIf w ew q M dvft.f, f,.p0 8:05 am M 7 2 3 -1978 8.05 am
- - - -----1--
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CERTtE1ER-NOME .nrt of nwti SIGNAiyRE ~ of ..fat tii?tE S,GNTD .-w-r
H~1DShdD.~Kadlvar NID 4.~ :~r~s~~v~ l~ Iz J~~ .D --12-5-78 - - -
'wuftvG ADGtESS- HI?ilt! , ra o.`.
a :."o ~ - ~•~oi ~o:~y,r ~_~-fT
~r .
arl. sa... S,t. :
~+r =9=t .URIAI. UEMATIpN. REMOvwI CIAttTEtr OR CtEftAtptY--NAM( tC1CAT1pN c.n w ro•~ s~.
p,ec.tO~L~~ rutcri.
~w___Burial _ ?b- Pine Grove Cemete Fort Pierce I'lorida
OwTE- .o..,«, o.•, taea ?uNERA? MOM[ - NAA4 Ae/p A r fnur o e • e.i ae ro fi. e
Dec.10~1978 __~r..~ Stone Bors North ~lt~ ~t.~t.~'~erce,Fla. 33450 f
tUN Al EC7 -SK,NA?U tl f. 5 A ._S~ -NItUIE D.ry ,IC I•.10 . - n ~r.. ,
~ .
-s :sa [.c Ana flcccmhcr h, 1'~,
f ; ~ ;
,Hereby ceriity this to a true end o~orrett copy d ttt! t~oca~ E. r • t
r file in the St. Lucie County Heahh D~plA• - "
E Registry .4 etord on
ment at Fcxt P~e*ce. Florida. '
Ep AND RECQRJED • : '
z
s -(Wan~,ng. !`vot valid unless ra+sed seal of the St. ILut1~,~_ :^_..`?~iJTY, FI.A. = - '
County Health Depa.tr'.ent is affixed.) ; ~ n i F ° E L
432831 ?
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N o. MI«= R r~ I(!~~, __rrrrtr ?(r?y~ffaa 2 PM 1 : 3~ . ~ - , ~ , , .
U=. e( ~1 a+ 11 ~ '
County he~lT!, " ~ ~
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OeputY local ~~~t.,i.f;~ ~:<K _ r~::iJI~ ~:;=t'
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