HomeMy WebLinkAbout1199 i
434194
DEATH CERTIFICATE •
Re: ERNEST W. ZIEBELL
•
L~ _
1.~ t'' -:~~a CERTIFICATE OF UNAIH
- 7.•p,trtment of Ht•a}Eh and Rehabilitative Services STATE .FILE ko. - . _
VITAL STATIS'f!(:S - FLORIDA
fzfctcTaww s ?+o
,@• .•be.f .•s* SER 1GAlE O,~Oi ATN rC r,w, 0.., rldl
i c t;n PRIN7 DECEASED--r+AME
tN -.GIILLIAM____- ZIFBELL ~?_ti{a.Le_~~ ~ece~nbeh 4, 1978
F t "r~S!ANENT s - ~ i
LACE r..n. •+wo. •.f ac •r ..0.•r. AGE -.•st .ra~f , ,faa Tv~.oef 1 0•. _ CIE C>+ t.RtM -c.rw. w.. CC>tJNir CN OE(,TN
~aACKINK tK .s?etrf, f.,,wo.. .f.fs, .os o..e wDuifT ad`f, ,
R tN.~P.. - - Sa 7.~ - se x _ i 6 /1 2 2~-__19 01 7f 8~(.evcurd F
CffT. lOwa, OR lOCA1fON CM OE ATM ,.sue ten Ir,rf eIOShTAi W OTHER NS111U110N-NAME ,w wp, w I.,wf 4M 1•Ml~ •re r,rrfH t
~ . .Ea ~ Rq~C6ow~ne _ - T~ Y_eb Ta Janea_ R. NoPme_
a Re~oyja.L_lNed~.cae Centeh
.STATE CM ti+tM . r ro, rr r / r•rf UTt2EN CM WHAT CtXlNitr MAl RAE O. Pt[~Et ffARtnED. Tutvrvfr+G SrOUSE rNf, Gm r•,Qf« rune t
_ .f cow+~f+t wto0 D. Dtv(~lCE ~ srecr.l
. .,.I,Otrtf , Glidcojidairt . U.S.A. ,t?_~a~.cecg__ il_A.P~ha youn99nen - y
rlcf.ft0 SOCui SEC'1tt1Tr ?+uwJEt USUwI O[CU?AtioN ,G~.1 awo or rota DO•rf f,rf.rG rose or- cwp CM 6uSfNESS UR 1401KTtT
Ot•s rOaa wG tut. hie w afntf~ 1 - ,
399-18-3200_ A~n<.ni,~fih.a~i._onLRe#,i~ced „D Pub.Gie Schoolb _ ~
:,-.1 .raft - ' osaf cm Iraq StREE1 w?+0 NUWEtt-' Al O7 #j
~ES,DEI•tCE-S7wiE COUNTT - C11T, tOvVN. C>t tOCwT?Otf ,srecN..~s M rO 1
F.Cohi.da ,•D $ltevand ~,k Indinn HQhbou~c Beach ,e Yeb ,.201 NQhboh City pQh~t~y ,
IATtfEl.--NAAtE ?ufr r,pwe uit M07rtEt-A,wtOENNAME t,qt r,e,0tf ufr [
1:n,seaZ Z.i.ebe.P.e ,6 U~iobtainab~e ~
" F.Con.i.da ~
INlORMANI-NAME - MA?tNG ADGfRSS Is,nlr of f.r0 r0, cN. p,prw, Sr•R, lift
ha Z.i.ebe.P,e ,~,Ol Hanbon C.cty Pa~a.y,A107,Indian Nanboun Beach,
•f?Wa,r• .w, f.4
,wl1 1 pEwTM wA5 CwuSEO 1T. _ IENtEt C?Nt? 0~4 UtbE ?Et EN[ fOR (off IDS, wND (tp ft.rfw o..us •re aasn
tt wuf..te c•rse i
f
Ventricular Fibrillation
. 6u~.
bi-•s
•~~uo.n•.~t-dT }
i
rw,cr G•af oft b n) !
Irrffr•n e•vst ret, pro. M
.•-s .-co~s+orf~ce of
sr•orG ref rrretf• _ 1
tnr6 C. trie !•1t f -
- ltl - LE
..n 1 NI AUTOIST M TES weft r,re.wcs cor-
,ARI ¦ OT11[R StGNkKwNT CONWitOt~tS. corarnors co.r•.f.fu,•rc a eurw fur rot al.ne ro c•uu G..tw rn r.fs Of .,D, slolfte Iw arffr,r.rG arse 1
of of.n j
t frgf ruruf! W Ir/6f. Ir !•tl t W a, R!r rR 1 - ~
jr ACCIp[He, StNCtD[ Oft DA ~WURT I+orr¦, o•.,,t•fl NOIM MOW IN/URR UCCURtEO
p uwflfwtNeo -
20a 20D 20c. M 120°
INJUlT AT wCKtE .FACE O, tt~hJtT •r wow, r•fr. s-nu, r•ppn, . tOCwnON . snm oa ¦ r o r0 . cln of rorr, sr•te 1
1 i•ferff ht Of we, OrrKf NOG., fK . S•Krn 1
20e 2tlt ~
.peer tr•. ,!•f wpwM D•t •tu •rD vl• s•+ w~~wta •1„.f Or r D.O7 D,0 .qr •:ew M DEA,M OCCVftlfl Uwe L•te, Ow er!
CEt1KKaitON- r.o~al o•• ,tu too, •RIf D!•M. IwOWt P e•n, •w, a elf ffp
•M+SK ~r1~rOf0 t.,f 7- 31- 78 To 12- 4- 78~ ~ DID re. ~ 2 ` 25~ ~t0 a.t t~iY,i~ s+:re~i
n. oece•sfo.for -LD _ ___Lr_e 12-. 4- 78. re -
efcfur~
...s rao•.a...cfo ow
CERTIfKATtON-MEDKwt ERA.wNE¦ C1R CCMONE¦ pr rwf f.s,s or rus wow W a•rr .O.rrw e•. p rfu wow
efuwr•ror p. M .oo• aro/of ry ,r.fir~,•r,pr, ,r r, pfw.0.+, M~nD 12- 4- 78 1 2:25 P.
t ~ j- f:l•A O(twaf0 O. H p•tl •rre OM r0 ort Cuff ril Sr•rf0 - ~
7la -TSK,NAT~fE ~ ~ eea w uxf _ DATE SKsNED ,ro•.n•. w•;,!ur
t CEfriftER-NAME
+i+n o~ .~wr,
~Q.-t~.-s..- ~ YJ ~ 12-5^78______
t
n, Timothy C. poirier,M.D. ~ --<<n Florldsa 32901'
nf,wfr ro
~;'~imo°~i~ ~;~E"~oirier~M.D. 20~ E. 5~eridan Rd. Me°Y`go"urne,
512. tOCAT10N crn Of tore sr•R
•+a. `977. Ip? DiJE1Al. CREMA7KN., ftE•aOVAf EMETERT C,t CREMAiOttT-NAME -
a _ ovcvs , f.fttf. r _ Bnevand Count F.LOJti.da
- 2fa Ch n ?tD P.ea'ti,utwn_Cocvs~-,- Inc. _ .a.c - -
(''t - DwTE ~ ,..a+*w. o.., .f •f, iVftERwt t,0atE-~tA.+[ ~r+D .DDR[SS , s+.ut o• a r e -o . ur: oa
~o~?.., s~•rf. ter 1
,_l X7/78 _ __~Sou~h. Bn.evand Fune~Ea.L Hone P.O.^ 1346 b{e~boevene F.eoni.da 32901
IVNE ~6'RE •t Q RtGtS RJQ-SlGvafuRE D•tl ftCE~rID f* /OC!t ffG!S,E..
~rl /1 C .
~.k',.,~~= ~ J. t?'?=.-.2159 ! ~ ~~~=~.~-,.E, 2FD.l~~~-_.-~~-~ ~ ~
. t ~ .u
I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE RECORD ON FILE IN s
THE LOCAL REGISTRAR'S OFFICE IN THE BREVARD COUNTY HEALTH DEPARTMENT.
('~~at valid;yc~~l5ss• the, seal of -the Brevard County Health Department is affixed.)
.-_,r ~ .
. •4 F1LE.p pNp' RECORDE`b~ ; Local Registrar-T----
~ ~ - ;CUyTY. FAA.,
'cti;;" - ~:~?;-LUCRE -~~Fi=D
.:eft=^ c. .
-
a
DEC~~~~• - 1978 43494 ~ _ ~ ~ ;f~ _2_.~ J-
~ -s1~ ` i
Date b eal ,T9 FEg ~ 5 PM ~Z • ~ Deputy Regi stmt i
- ~ . r {
D. GENE ROBERTS JOHN HURDLE VAl M.f~~.~ r~-'g~+~~~I~A JOE WICKHAM ROBERT L. NABOBS R. C WENSTEAO. JR.
~ '
~~t.... ^.ar' -
a~~13 X1198
. _ -
i -