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CERTIFICATE OF DEATH
Dcy..ll.e»l el( t1edlL Bad Re4\AbililAllve $ervicef R[TATE tTILC NO.
nlvls[oly of 14w7 n1 FLORID A
1Y?E, O! ?tlNT IN tl't"~•"•"!••"° REGI6TRAR'S No. 360
?ElMANENT INK DECfwSED-NAME nuT .rooae a•aT SEK DATE OF DEATH I +o»TN, s.r, •!•f \
~.s~,o,`0R ~ Wilbur Bernard Dabney Male ,July 25, 1972 .
RACE r»In, »lato, Arlflc.» \I.OuN, AGf-\.u Y«a!e 1 Tw Yrw! 1 w• ,DATE OF •iRTH I»OreTN, o••, COUNTr Oi DEATH
!K. I fIKN• 1 Nnr•D•t 1 q•ef 1 raf Wf NOYef rw. •4t 1 ,
6602 . White 57 ~ E 11-17-14 ,.St . Lucie County ,
TOWN OR pCAT OF pE,ATH wave clTV \r.n MOSMAI OR OTHER IiSTITUiION-NAM[ IN IrpT w lNINt, Gr! fTrlT •10 Ir11NtIt I
"~or t S~ t . Lucie s•lcNT .!f o. .la ,
Fort Pierce i/ no i1 102 N . E. Tunison Ave . , Port St . Lucie_
STATE OF RIITM /N woT r Y.s.•., ».W CITIZEN OF WHAT COUNTRY MARRIED. NEVER AWttlED, SIRVIVNC' SOUSE IM rNf. LwE rMelN »•~N! 1 .
• cowTt•1 WIDOWED.prvORCEDIfnc+•1
YfYY Hfnf»C! ~~r~c,inia U. S~ A. Married ~I~ Florence Carter
rWa eece.us SOGAT SECUtlTr NUMBER USUAI OCCU?wtgN ruA erw w rOtll oa.e Ryelrr0 uofT a Rlfq OF BUSINESS Ot IPDUS1Rr
l1YlR. » oufn rp4Yq \N!, !11!» N !!tNlD 1
225-10-3430 „ Iron Worker „ --Steel Construction
«snTlrtrD», aeln
!l LlNle(! tlget ~T rflw cm arM SifEET AND NUMBER .
•orlssroN. RESIDENCE-STATE COUNTr p,r. tOWN. OR lOG\tION
~lareun Tes a nDl
,4 Florida ,uSt . Lucie ,wPort St . Lucie no - ,M 102 N .E. Tunison Ave .
IATHEt-NAME rufr • r.IROa! \AfT MOTHER-MAIDEN NAME rrfT rltoa! \A,T
,s William H. D bney Myrtle E. Jones
INFORMUNi-NAME MAlwG ADCREU IsrnfT o. er s. rro , cm o. lor». sT•n, !rT F lOrlda
I?.Mrs. Florence Dabne ~In102 N. E. Tunison Ave. Port St. Lucie
.HtD¦W ~ tlYY
?A!T L DEAM WAS CAUSEO tr, {[NT[f ON[r ONE CAUSE ?ER 111E fOt (e). (b), AND Iril etTru» o»fn •w. of•iw
1• IYYa•n
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I CONOITIO»f, Ir •Irr.
nrlf/r.i! CAYlI IO/, ~ aV! 10. d •f A CO•ILOYlrK! o•'
fr •IINa 1Nf Y»t!f-
\TIMa C•Yf! L.fT
AUTOKr sf rE1 ru! n»oI»of co»-
?ARi ¦ OTHER SICsNIFK,ANT CONO/TIONS. CIYeOrbOn1 COe+T\NYh»f. W O!•M Wr IqT nur10 TO UYf! anlnr r.n 1 .m
(Ins or •eDl f+Nno 1» wner»wI»a uwu
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~,??.r~~ppo~Wy~~) wCCIOErlT, SUKIDE A E WIURY I .o..rN, TI•T, Te•f 1 W INIURY CURBED r lr.rlt wTYn o+ 1»ru tT r r•n 1 p1~r.n~II,~NAy[-. .1
IgM1C10f: {ROE1EtM O i~ ~f ayQ.(.(_.~l , ~ ~ .a~`•'-~
IDA M L.CGt-v ~ 7U , ~ ~ ~ I ~ 7h e• r ~ S M 701 V 1, - C
INA)tr Ai WORK WAGE OF W .r . ru», srnR, r•CTOtr, IOCAT1pN ~ ~ s¦u\ ¦ r.R .ro . cm M Tor», sT•n 1
I fnun ns »OI Orrl[a e\sa , eK s In l ~ ~ ~1 / t t/ ~ a / ~ - ..17_ /
CERTIFKATION- era»~ w• T!•t rD»Tw D•• •!•e •ND 1•fT Lr Nr/+!. uM O» I °O/OO Iapl YNT/ nN DEAfN OCCYt![D AT M 14Cl, O» M
?Mr11C1AN: TO »y.TN W TTU . faaT •rnf w•M. r ~ MR, 10 M YfI
1 •m»°!° Trr! .Ilfi/ld «.s frpr\f°a!. ow
f7e oeclslon°» Never °TU Never '711 Never Tn 1A TOnNC.YSel:raun°.
CERTYICATION-MEDICAL EIIAMINER OR CORONER: or. T»e \•s.a a Tr+ Irow o. w•Trr rwe wclof~r r•s .ao»oYr.ceo w•o
ffA»N•rlOn d M eDDT •rrR/Ot M ~VlfnWl~p», w w• dwr0~, ~~LS rp~Tw7 O•i IOY¦
wane occwero o» TM o•n •»O sue b rw! uwenl sT.Tlo d r ~'S ~~~M~77? I~ ~ 7 1 - M.
n.
CERTiF1ER-NAME Inre a •n»n , S TURf ~ n ~ wan! o! rm! ^ DA E SIC,NfO Iw»+N, o•t •wl
IT. R Calixto Ini4uez M D ~77.~ .Vl i~
MAKWG ADORESi-C[Ri/Ff[t store. of ¦.r o w. ! c n olrw~ sT.n to
771 Ft . Pi rce M orial Hos P 1 '
. BI)tlAl, CREMATION. REMOYAI ICEMETERr OR CREMAtORY-NAAaE lOCwilpN an o¦ w.» sun '
1 fNCrN r 1
Iw Removal Ie.Riverview Cemeter LeRichmond, Virginia
r1 DATE 1 »Wrlr, w•, n•n FUNERAL HOME-NAME AND ADDR[SS I snm of f.r.o »o., cN. o. to.», soil, nr 1
:w Jul 29 1972 Ft Pierce Funeral Home 106 So. 4th St. Ft.-Pierce
V. 5. •612 fUHE ECTOR-51~jflA REGISi SIGNATUtE own tECEnEO •r sow uclssw
1. r.lvio „l ~yu ~~U ~ IY Jul
s
I hereby certify tfiis to be a trw and Damsel Dopy of tfie Locsl '
Reglstrae's nsoord on Elk in the St. Lrude County F4eahfi De~per>d ; : ~ t ; = C G ~
. C = iJ i
irnnf at FDA Pierce, Florida. - _ V ~ T r _ r . '
i
(Worming: Not valid unless raised seal of the St. Nude - ~~p ' ` ~ '
Canty Flealth Department is affixed.) 438~~
pt,~ ~ .
56
N. D. MILLER, M. D. 79 ~,:E _ ! i
County Health Officer dl Loal Registrar
De(xAy Locorl ReQistrs? { ~ ~ ~
~0~ 1 25fi5
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