HomeMy WebLinkAbout1803 X34580
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Uepartnoent Of Hea1W and RehaWlitatiT+r Ser~ioas ElrwTC PItEt Nc:
VITAL STATI8TIC8 - FLORIDA llccla~rnwlf s No
TYPE OR PRINT DECtwSEp-NAME ~ '»r• rneae t SEX DATE Of OEATN +ortr e•• rru~-~--
IN CLIFTON G. MacGREGOR ,Male , Aril Y0, 19~b
PERMANENT -
BLACK INK RACE
~rrln. rww •wtac•rr r.a•r, AGE-uI? .•et. 1 n.. w.a. 1 w• CwTE Oi MRTN •.waw tw. GOIMfr Of OEATM
rw`~'~White 721•f..fr 4.rof ~ ~ ,~lov. 30,1905 Martin
Cllr TOwr+ l A .islet en• awr?f NOShTAI OB OTIIN Bvs - Iw rW w err»e e»f anto w .rrrreN •
frtc+• n! a ra .
Stuart _ yes .,.Martin Mem_o_r_ial Hospital
STATE Of BIR1/1 rr rot w r s • . w•rt CITITEN Of WIMI COUNTRr MAxtlEO. NEVEt MABREEO. SIIh?NNG SIOUSE rw ""N"' r•rI '
ccnrw?1 O. . frtcn. ~
.,,,.,.ta...r. , Massachusetts , _ US_A N~arrl Jeanne Gordon
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.I.rc • a•r SOCut SECUIITr NUMBER ~ USUAL OCCU?ATION ror•t awo a apu eOrt eeerrr0 tuft M KIND Of BUSINESS OR MDUSft11 ,
OC.wMO rOrrrrG ar». Mr r nMM
rtrrrrr.a..~ „026-12-2981A Manufactur_e_r'_s Rep. Restaurant F:q~,ipment
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•ersf•o. RESIDENCE-SPATE COUNir C?Tr, TOMM Ot IOCAikflH rslee cw• aarlN STREET ANO NUiANf
I anc». •n a rro
Ohio ,Lorain ,,,Columbia Station ,N ,423798 Royalton r?c~
rAIIRiR--NAME ~ nest ra»eu ~ w, MOTNEB-iaAtpEN NAME rrar «eert
s Guy MacGregor N Unobtainable
Ir10RMANi-NAME MAKR1t(i ADDRESS uwp s e r e rro c n a ro.n+, fr•» t+
~hCorrigan Funeral Home „247-68 Lorasn Ave., Cleveland, nh,-:
?ART I pEAHI wAS CAUSED Br (ENTER p:Rr ONE CLAUSE IER LNE N~a N/. AL A?+D kN __~w?wt» orw•
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al ~ s ~r i et /era f~iti~ct _ _ _ .
cowenrp+f. + ..r.- / ,C• `QCr_ c ..70/sr~t„_ - _ ~ ~
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eAtl R OTIIEB SIGNIFICANT CONDITIONS: correr*ors carwrewrre r0 et•nr tail ro? etune ro weft o»tr. w r•t? . Ter wIITOfKr • TES .t•r
r of ~U • . wettae n. etnt.
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~Trif r.a•?.. e•• nut NOUB NOw IN1Wr OCCURRED Iu•nf r.rw a Ir,w• ~r ..n o.
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CEETWCATIQN- rorwrr M• nY rWrrr Ms •!u •re Mat f•r rr/rfe •\M Or 1 M/O» rpt •+r nt Q+tAM OCCUMl4 • _ ry+r • , •
IIIr,1Ci•N: »Q»M M• ttY eow •nN M•wr IroM+
[E fI. ::ai.~towrr 2 Z 6 7 8 ilil? 4 10 7 8 •,I, 4 0 7 8 ~ S lil. / ! ~ s'`!t" •:r. "
p CERTEtICATION-MEDIG?L ExAMR'rtR OB CORONER. or tit t•s•f a rr» row w M•wr ?rt etctaM .y to ~t•e ,
9¢ rt•r~.ne.r a nM we• uw~oe mt rnfnwror. w .a o.r~or. ~orrw e•. n~f..Q .c
et?M OCCYtete Or M evert •rre eet b art U11ft1f1 fng0 M. fT1 4 O ! "
tE.TIfIER_Iwiw[
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David MacMillan,.. M.D. L_, ccs ~C~__- _
MARRJCr ADDRESS-CERTIFER srrv a t r e ..c. cIn d ~o1+r ar.n
416 Balboa Stuart FLa. 33494 _
BURW CREMATRJN, BEAtOVAI EMETERr OR CESMATORr-NAME IOCr?TION ar. M rm.• • . f
. srtcrrr .
Cremation H. Necron Crematory _ West Palm Beact,, F'iaJr 1
DATE rrpMw, O•~, 4•t. +fUNfRAI NOME: NAMI AND A1)pRlu frnlt o. 1/
i ro . ta*• w rtrrr a•.,.
'1 12, 1978 „t has Funeral Home 961 Colorado Ave. Stanrt,Fia.~~
V.S. X1612 f - OB- REGISTRAE --SIGNAfUlf D•n etctlrto ,rx•, uclsru•
E Rw 7/76 '~~.t-t .~1 ,M r i i1t~>~f-~ tM _ 1 ~
.
I hereby certify this to be a true and correct-
copy of the Local Registrar's record on fiif-
the Martin County Health Department in Sruart,~
. Florida. ~
C ~
- (Warning: Not valid unless raised seal of the
_ ~ s . - , - Martin County Health Department is affixed . )
. -
i ~~LEO ANJ RECORDED Archie McCallister, M.D.
: ~ .~C" AUNTY FL.A.
. fi;;Cpgnty Health Officer & Local Registrar
_
a ~ ~ ~-'~9 FED 20 AM • 44 T~ _
Date Deputy Loca Registrar
,,Y ~oax~l3 ~~EZ~I
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