HomeMy WebLinkAbout2935 43533 ~ -
l=1LEQ rl:D FECOROEG~~
ST ! UCIF COUNTY, FLA.'
~a~J~~
IN RE: ESTATE OF RUTH G. KEMP, DECEASED 'T9 fE6 26 PN 3:39
Lot 17, Block 194, Unit 16, Frederick Town, Interlachen Lakes
Estates, as recorded in Plat Book 5, page 4 of tom, ;~~b~,~c;;; 9
records of Putnam County, Florida. CLERK CiNCLIT ::oURT
CERTIFICATE OF DEATH
• ,
state o[ Florida " CERTIFICATE OF DEATH •
Department o[ Health and Rehabilitative Services trrAT[ Flee No.
' VITAL STATISTICS FLORIDA ~ ~
REGIiTRAR-s NO
TYPE OR PRINT DECEASED-NAM[ •uf• ~wat1 t•st SE1 GATE OP OEATM ~ IIONtw, e•t, +tu 1 i
1N Rath G. Kanp 2 F~ailale , De02mUer 28, .1978 '
PERMANENT
BLACK INK RACE.•^Yn. Mraq. •NetMe•N a.eYN, AGE-t•at v..et{ 1 +e•{ IIN01{ 1 0•+ LATE OF RtRM ~YowN, COUNTY D/ DEATH .
11C. 1 r1NCY:1 Malq• •.{1 aIp{ Mt{ Iletra{ n
>idzite ~ GZ" ~ s<- 6. ~iril 21,1916 Martin
CITY, TOwN, OR l 110N OEATX N{»e cm Itwt{ IIOSPtTAI OR O1)iER RrST1TUTION- Iw Not w uWa, a1M {t{III Mi NYwn 1 }
Stuart a Martin 1?Sanorial Hospital
70 7e. id,
STATE OP 61RM /w NOt w Y { N•rt CIn2EN a WHAT COt1ee1RY MARRIED. NEVER MARRIED. SURVIYtlG SPOUSE Ir I+re, owe r•eeN 11•W 1 '
cowiln / WgOW*Ep~ DIVOR 1 snot t
f~~u IUw«ce ; O08<IIIeC.tlCUt 9. 10. 1'1LlLi+'r~• 11. j A. ."`.`r i
-.111 acufee -
„ w•IN SOCUt SEC'11bT1t NtJM~Et USUAL OCCU?ATtON Ian a.eo 01 trpa aoNe ewawa .~wiaa IIMaD OE BUSINESS OII IPn{ISTRY
~yci urtl0 YI OaalMla Iaf, MN N wMN1 '
t: 044-09-6170 ~Y ~~~n4
.I1 o1»ct NIOM 1Ja. ~ lb.
.o.nth~« tESIpENCE-STATE COUNTY CITY, TOwN, OR lOCwiION wslN cm Ira{ STREET ANG Pa?M6E!
Florida ,•e St. Lucie ,K. Part St. Lucie ,bra' Yes~l,ae. 12 Antigua Lane
TATt1ER-NAME r1a{r ~ Nlaou test MOTHER-MAeDEN NAME rr{t clew{ u{t
15 Clifford R. Hawley ~ (Unavailable)
tPeFOR/MANT-NAME HAYING ADOtEii wtMa W a t.e. No, em Oa ta.rN, a•w, ert
' Henty A. IC~amp . 12 Antigua Lane, Part St. Lucie, FL 33452
PART T. pEATN WAS CAUSED 1Y: IEN/ER ONLY ONE CAt/Sf /ER lwE TOR pl, p1 ANO kll awe
ewaow{t'w
Ila•ttt
tt. twww i -
N). ~ 1 - ~ I
• j
CONNt/0N{, 11 •1rr,
tYMICN a•+{ 1111 q (~1 •
/YUtaN•q C•Y{e 101. M q. Oa Aa A COwff0larlCe p:
{t•tINO 1Ye YMeee~
I+1w~ C•YM I•st _ - -
i 'C'
?ART a. OTHER SIGNMICANT COPIWTIONS: torlwtlaNS Co/ealaYtYto q ewyY {Ia Ilat tutee q t•YM a1+flt w rYt 11.1 AUTOPSY ~ YES IYUe naNwas cow- '
1 m a 1 {1Naee w Mnarlwwo uYft
t/1 ~e. / - ~ /f M elA1N
-sj Gif' 'I (/~W~• it X-: 1 IA.. 1 18b.
AtxtoENT t ra/tN, e•r, nu 1 110tH etOw tN1uRY OCCUUEG t erllea wtllae lw /NrYar w r•at 1 w.rut a, aer u 1
N K1 t, O! NO~IEM{wEO ~
200 20c. M. 200.• ~ - I
' 1NJWY Al 1MOR[ /LACE OP M •t Now. r..., st{eet, raK'Ipat, IOCATtON ' 1 unp M a-r.e. NO., em W to.w, {t•te 1
~ 1 {Iat:11f +e{ M NOI OrpC{ 1'Y6-, aK. tlraCrr 1
r I
2'Oe 201.
CERTIFICA110N- at01wN M+ ~ t{Y NONM M+ teY •111 4{t Yt+ IIIN/Yea YI+{ Ow 1 011/Oee Nat +wtr tae OEATN OCCVNEO •t 111a rtA[e, ON w {
I ?NrsK1Aw: TO a+Owtw e•+ nu eoe+ •ma N•M- 1NaYa1 o•n, •ra? p w a!u
2ta oectnue?wW. `I( ~ ~ tf ~ ~ ~ ttc. ltd. O tte~ ~~~M to w c~niiun~f.
~ CERTYIGTIt)N-MEDIC/tl EAAM1tifR OR CCttONER: oN twe {•{I{ M w IIOIM M Ol• t eaeea rp reu/.a1,.Kea oe•e
e r•rY.•I.Q11 0/ w t00+ •r1e/oe w IN+t{tIp•IgN, w w OrrtlOu, .ONt« N+ +e•a YOY{
w•w Qccuwe a w e.w •NO awe q ttr e•YU1a1 sl•Ite - ,
1Sa M 22b. M ~kk
CERTR 1t+M M raw T eeaau Oa r/na A E S1G,.Ep'.IONaN, sl,+wt t
23a tZ ~ ~ 7l0 ~ ' r C'•y~ 2Jc. oCC ~f~~ ~
MAY - tTlf~f .atr a a.r.e - Cm p ~ •1e • y
ins cmo SIl. za•t ~ a J ~ r ~ /C i
v,1 1977, tR? 6URtAl, CREMATION. REMOVAL EMtETERT M/t ORY-NAME IOCAitON uu a IoaN sr• ~
aacr+ OPCVS 1{rytlr+a -
"~'6/~ 2u GYeination 2a0. Fort PieL'cce toriu~n tk. Fbrt Pierce Florida
- - - - '
~ DATE Ia101NY, wr, a.a1 tUNERAI NOME-iaAAK AND AOOt[SS - -1 {Irtu o. a r e ..o., eIn w towN, {I•N, en 1
2aO Dec. 1 978 251 Y • P Box 777- Fort Pierce FL 33450
I T'U1dER D E f iWE REGISTR SrGNnr1lff ow elveo aT toe avant Ae
I 250 ~ - 260- ~ P/l1 7i1 ~ ~ 9 7 - {
1
I hereby certify this to be a true and correct
m copy of the Local Registrar's record on -file in ,
_ - the Martin County Health Department, in Stuart,
- r Florida.
(Warning: Not valid unless raised seal of the
Martin County Health Department is affixed.)
~ - . . :
. ,
- ; Archie McCallister, M.D.
_ County Health Officer & Local Registrar
~ -
r
e .
Date Deputy LQcal•~Registrar
F ~
Ln«NI•ACY
~ P O wtc 1270. FORT PIERCE. FLORIDA AA460 - T[t.EPMONE (ADS) ?A4-aR00 I r1 9j{