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' State of Florida CERTIFICATE OF DEATH
• DspatlEneat of HElalth and Rehabilitatire ServiceR trATET rlt,t No.
' VITAL STATISTICS FLORIDA /
R[E;IaTRAR a NO
TYPE OR PRINT DECEASED-wWE au, .yNl i•ft R OAR 01 DEAM ~ rout«, ut, ff . t
PERMANENT ' Su Geiser :Female a Jul 7 1 8
BU1CK INK RACE ..Iln. rfeq, •wfK•w tllel•II, A~__i~p ylleff i r rf y.lefl I wt CAi! Oi EWM frOllrw
ftt. f wcrf t l.fele /teal Ifof eat rowf ref. N•l I ~t• COUatr 01 DEATH
~ 1 ~ k e Dec. 6 1 Paint Beach
tOwN, OR l TION AiM .+flef cm ?elln MOSMAI Ot OTHER NSTIT fr ttpl Iq ufrf, cln olio are /lwN f
~ 3 D fncr..a o. ffo
1 ~~Yes ,a St, Mar~r's Hos ital
STATE OE EIIRTN t N w01 r y , . , II•.f C7TIZEH Of wluT COiI!+TRr MA~RI[O.
NEvE~ MARy(t,. SURVrvM(, Sfq,SE
~ y .w. ant luw«
a.w f
cowls I wR)OwEO. EIfvORCED , wcr.I
.f« u, S • A, ,o Married _ f f Geo a E. Geiser
fe r N•er SOtaAE SEC•JRITr roUwE~ uStiAE OCCU?i?TION Iwtf .p of roll .ow.w»w aoft a
~f rfffe M f/Qfl ulf iln. MM Y efh\N / Kip « E~/S~S~ OR R~OUSTRT'
ff fYN~IIC
MbW f2 . . ~
...rf,1pl,. tea of Teacher „e~Eiement SChol _
RESEpEMCI--STALE C01MTT pTY, fpyyN, pR IOCATIpH Ir/le. crn ?wlrf STREIi NtWR[
_ \ f wUtt tU M ffp
1e tk Port St Lucie t.p No tw 70 Lomas St.
fAT11ER~Wµ1E rilft IfINN NY MOTHER-MAbEN NAME flgf
4R
is . Grace Sny
l:~.; ti IwoRMANT_NAME Dehn t• Susan der
. - _ MAIEIfIC, ADDRESS atoll a l.f.e. ao. cif. a tp.r, ff•te, lr1
f t.
tTe Lomas St. Port St.'Lucie Fla 33452
. ?ARi I. OEAEM wwS CAUSED Rr CENTER ONtr ONE oust KR /NE fOR
fR. N• NL IsA. Arb TfH . Iw
fffltrffM OIfNf .Ile N•
. cOMNNpMI, n .Ift - .
relf:e O•.l fill fQ hT .-~.-.~.iG.L~ ~~'~.M/J~ ~
1falMe fel rflNe- ew f0, p a • ffgilf/Kf Or:
Utff~ C.YM 6?N
t.) ~ I~.-~ _ .
- i.. ~ EART OTHER SKiNrKANT COf~I/IONS: cpIMTOI.! cOMMMIwo q e4.y~?w•'`.yt opt MYn c•Yf! 6t+tr M ..If t MI AOTOPir M rES ~!O arNr10! CO-
L ~ thf Ol IIOf MN.N IN N/fWllrfe fa
M .law
i I..~eMrl ACCIDENT-SUf f~ A IYs NU t!e
~M I OR IIrOITEWtNEp t.owrw, e•., na1 IIOW INIURr OCCURRED f fllffl wNy a /Mglf III rat f M r•.. r, fffr Ill
20i 100 ~ 20C ~ M 100
IN,{,Rr Ai WORK TLiCE Of NAlfr •r Inw, r.rr, Frfff, f•gpf, IOCA,IpN - I fnuf a l.r.e. rw., an o. rorw, fun t
ffncin of Ol lqf pNKI fieo..lfc. 1fNCrrl
10e ,q - p0 .
CERTITICATION- ~ IIOIItw O•t «v •Ipnel
/tnEKUN: eft ft•l ~Nyr ItYl .rll y pII 1 We/O Ilpt i w NAM OCCYNlO •t tM rucl, OII w
t .ttfwNe nIf ~/f (x'~TO ~ Y eoet • Illprf l O.n, •wp. f0 w M•
2te OfC.Nfe rqr !j / ~21D / ~ - 21c - 11O 3: 30A or alrpr?flpf.
tER~1f1~wtION-ME01CAl E~AMMIER OR C !DRONER- o.. r¦f s•sl fwf r~. M fo Iw uwfcuf fin
ft••Irl•hpll Ot w lpet •Ile/Ol fM 1•Itlifyr wOYI W cowl w ffMwt w•f rgt10Y,Kfe ef•O
bM, III w O/M/yl. ~ rplfw Nt tf•/
N•tw OCCYMle Or M O•R •IIO eM f0 w (.Yftlfl ft•n0. ~ ~ rprl
rn
M 22D. A
CERINIER- mrl a rn..n
1 ~ C / 1 ~ ~ a .~nf ATE SK3NED 1 qu
MAR, f KR ftM1t W AI (tff OR IOr.I
NRS fplw 312. 2lp ~ }t.n !
,vim G -
Ip? DIIRIAI. CREMATION, REMOVwT EMETERr OR CREMATORr-n,AME
cuur OPGVE: ffMClnl _ g i lOCwi an p fog.. st•n
F,,,~~eRfn ~ ~ Cleveland (Cuyahogo Gc hio
2y Removal 2~est Park_ Cemeter.~___- 2jc _
2 RJuly I.•otl.l.~~nu I WNERAt NOME-,~uw( Arq /tppflSi tsar o.. f e ..o . c• r o. MM st•t~ , •
. - , • 17 / 2s. Ro er L. B PSL • Funeral Home ~51~ S. Fed . Htiry . Port t . Lucie
TUNE DRIEC70R- f ~ REGIST -SIGNATURE /
zso ~ t ~A olln leclnleo ?aca aclfn:e
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~ I ~HEREBY CERTIFY THE~~ABOVI=PTO BE~A• T~tUE ~`ANO~CORRECT~~ ; i
- ' COPY OF N~~`REGTSTRAR =•S~RECORD 'ON FILE SIN .THIS ` FFICE 3~'.
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. -_f Not.va~id~unless-the~seal~of•~the;Palm._Beach"County~;x
I" ~ Heal:tl{~("Department,~is±af xed1 ~
_
11 i ~~t,,,'" ~ C.L: Brumback, M.D.~`~~~`~~ ,t; •
i July 10, 1978 } ~ ~ Local ~Registrar.• ~~t
S '4 ~ .~t ~ ~~~f~~J Bureau of .Vital Statistics~~`'; a
` ~~g q v. ~ I , West Palm Beach. Florida .
~+f~~~tf i r •'E ;:,cif r'L~~~ a t L ~
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~ P - T"'LZ"D •1tr~a'ti[Cbi~v'
{ ,T i~ntc rC1UNTY. F!
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.ATTORNEY-AT-U1W
5'28 5. federpl Hr~Y.
~I. S,. I~».?b-x.52 '79 FEB 5 AM In : 06
CLERM, y:RCV~T CG~RT
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