Loading...
HomeMy WebLinkAbout0582 ~ 439~13 , ~ ~ ~ . ~ ' i ~ f - ; CEt2TIFdCr~TE OF D~ATH r- . .oc.~ ~:.t ~_.~u 1s~~ r~eH af r.olY F:.nA j ' ~~~f~ ~....u 1 % , tcc~co-~e VE RA' ~a+, :~a~ =SFa !•C~tE G~ CEaTr ~ •'Ow~.. a~r, q~~ ~ ~ ~ . HU7EK ~s,.~r=:~~Is 1~ i.-- : ~ [RCE .-~n. .lcaD. ...:a.:.w ,.our. ' A:,E-..17--- ~ .i..~~- ~ ~ / O ; ;+l~*~'{~~. n: , v~c.r~ ~ . •.c• o.~.~.u ~ o•• O~'f Oi I~ptl~ ~ w:..,w_ c.r_ CUC;HTIr Oi OE~iM \_v..:a.L ~d ~..~t ~ ~K.f. ~:~~1 '~J~~! r.V. tilV. MQ~r~~'li7 . e bf ~ i ~ I ~ i °~3„- 1;^~ CRY, iG~N. Q~ :jI~T~~~ pf p(ATN 1 wswe aniw.ri 4Qj?ITAI Ot OiMFt lfSTlil•'i+C~lV-~VA~!f i.~ w: t: .n, c..~ ~•at7 ~.vawa ~ sncur ..t o~ . :ti'Ar2RLiV, t:ICHIGAN C,~ ye3 BI--COUNfY CO~~MUNlTY NOSPITAI. - - - i S'w:t OI idiM ,r ..or ~ s•.., •.,.e GnZE~a OF w`~?T COUl:tlr ~tw~n,fD. NEYER .uARi=f~-p-TSU[YtvNG S'OUSf .?rt, 0~,1 ~A'KM A~Y( 1 ~ ccw.•a.. ~ w+DOwEO. 0~'QRQO i s.acn ~ tKl.H ~ r ~t~~ ~J • 5 • : • ~t~ ~~il : _lE~ ~11 I~I) .EC u a.n. S~X~~I SECI'bR AL'~tift ~ UStw! UCCUia~`pN ~a~~t aw~ O~+axi ~or.a wuw., roa* O~ ~1(~10 Of WS7NESS OR 1NDUSiR11 . ._~.reo r •.vu~.r, e.re. n[. e~t-.~w ~ , r ~~'iCw. 4.v[ ~~.ce uwr ~j~~-? ~:r ~:ll'c~E!:` ~@ lA i~CZTlB :c•• ti5:~;?rCE-Sl~fi `CaJI~71r ~C::1t, ~CwN, Ot IOCw~10N r.i+ae un is.~~ ~S!tEEt MIO NiJ+~lE~ ~ , ) ~anc~.r .~a cs .,o - - IMi~~l:~~cF~~ ~IMI'~i~~~•-~~. . I14 Jl• ~~c~.~r S^l~'~4J (1f~ Vn$ ~li~:~tll/ Z'r~~i{3!~ p~ •f - a_ 1V7. FwIr~R-wc+~E .,,~t MQT?(~-A417FN NAIME l~ _~~i. i~ ~wr .~oe.e us~ lf iT'js'~~tls~~l Rra!R I.i:.'S~ ~N ~.~5'i:_. l:j'!?? i N~OiIMAN?--'1~WE ' ^Mqn~K+ nDORESS •snet+ o~ i ~ o. wo . as. u~or.., ~~.n, tr~ ~^T! :'~'ItP.~{ fi•~.,t,~ 3t q: ~ ..,4r i - _r 5^0. ~~c, . r ch ~ -.(~S ~EwTM Wtt C~USta (fN?Ef CY~[r Or+E GUSE ?fR t7.^4 fOR (01. 'b~, ~~+D (~r ~.?r~ ie..~ ..a: ~~K i . 1~ wnlCU!! C~tlf~ . '1th~t[w O~eXf ~r~0 W~in; = ' i i t~? ~ e~~• ;7~ V n f~ s:t ~ci, A1 i N/=- A R N a~'i o ~1 1) s. n FLi'~ co~s ee w. ~ ot 11..~~ ~ ~o~o.-:o~ s. .•n . ~ I ni G ~ a ~ R~ . T~-~q a_1r~- - :r~::wG iwt '1:r~L:~- ~ :w! ~Q M ~1 ~ l..wllQ-lrr:E W. ' _._'___j_ • v ~ S. \11N6 C~YS~ t~fT ~ - - C ~ ~t o~~e~,~_ R ~~r.~ ~ . ~ c w . ~ ~ r ~ * s~ ?wtT OTt+Et S~Nrtl~wnT ~~vpT~raS: cow~-.o..s cor*• H~~w( ~Q p[~M {y~ ~i fII~RD 10 4yS~ ~n~Y w. .ur . w. wUiOK~ i YES ~e~e r:.o~..es ea.- ~ •.:s p w~ no~~ro n. ctua.u~ivo un[ 11* ~T C[~tM ACC~OEM, ~l~Kh7c. ?iCMKIDf. ATE :tYJl:ir ~rO~+tw, D~~, ~~~t~ (Fw7Ut HpW INNJtY OCCU[tEO <<wfte wn~~! w~w~n ~e. r~n ~ oa rur x[r ~~1 Oit U!eOE:Ef~AtlrfC ~ s~qe:n ~ ~ ~2~ ~2R M. Zfl +~ul/[v AT »CiK /lw~E ~f r~t~.tr .f ..c..e. :•e... s.at~, ~.c.~,n, iOCAiION ~ srnn w ~ ~.a. ~.o., un e~ ~o.r, s~~a ~ . s?etm -~s w+c ~ ~w..t~ wue , a[ ~ snerr ~ ''b ~=r ~7~1. CER7iqCa:Gn- ..a~.n. oa. .eu ! w..~w . ?NtSK!AM• D~~ ~(a~ i wr~D 1i5~ ywr ti~~ rt~ atM Cv ~ pi,/p~p ~„p. y~tyr tw~ .iw+w o.• ~ ~:a, .rn. -..n.. ~t.r.. oecuf~to .s r«e w:~. a. l~e , . ~ •-n..a~o rwe t _ ' l ~ ~ ~ T~t, ! - ~ ~ ~ ~ ~ ~w~~. c.n. ~w, ro M rs~ ~t~~ ~j - g_7 o S a... ~.w,EOC...~e n. ,«~.f~o ..o. ~o ? 7/1. r ~b ~ : ~M. ~O ~r~ GWS[t11 fLRO. CFRiJiCw:.G~-Mfa~[wl EzAarL+t~ ~t CG:Lk~EI: o-. r.e us~s a:~e .o.n e+ oe.•w twl DFrl~M ,r.s .~o-.a,+cen ai.n { ` f urwa:~~+-O~ M W~ a~:: c~~ !w! wrlar~.~~Ow. aa u• Wr.py~ ~.WfM O~~ pV~ ![~'M :.C:~~~N G+ ~i ~.R u~G O:R ~O M Cauff:L 11~RY. ~ CfRl~.~s1.--~:~ALc .~`t tc~c--- - + _ M l~ K ~ ~T ~GNATURE` ~t~ut ot tn;e-~ :;ATE ;IG.^1fa i~w=~., o.~..~„~: ~ _'.~~i tk ~~_L~1L S f ~~`T c=o h , L~.~~({1 C.~ ~ - ~J M~llf.fi RD•JifSS-CfRt~f{r . s<~u~ w~• c~.e. -~~~~"~ri o+ w...r ~ u.R 2l1 ~ tr ' ; 1~'3 w, ~ w~i r] ~1.,-r-,L, ,T 1L1 ~ C es;¢~wi. r,~.,c-~x+ ef~~.a v~,EZr oR cr~M,+rcar-H.MC cccwr~or. c•T. :o... ~ ~ ~ i,..e "~>>r~ fil • ; ~ n Gr~Jl@ ! P.c~evi:'P, :._c~i~an ~ - - f ,a:e DATE ..e•~w a.•. •eu. fJKfRAI NOME-MA.Mf I~:D ~~G~ESS ~ snie~ c¦ o. »o . een oi ror., s~.n. t~~ ~ - - ~-~5 i- _2-- 1°70 ~:~t~o~ ::au; ;lr.•nral l:o...?~ ~nc, ~ St. ~%?sir S^:orP~ 1:~~~ ~ ~ny~ , • ~ f~[vERAi-6'a°CT -i~Gt~t)• RfGISTi~R-- i - ' ~"G8 , j 1 / t ~ i ~ Cwrf RECEn~FO ? EGK•!!`( '''}A E 7n'1~1,5 ~`7L?G~: f ~ ~i f : / ?h~~~ ~3~/ ~ 7F! •f~l~ ~ 1 1 / l1 f ~ • ' ~ `t S ' . ` e ~ - t ~ . Y _ ~ ' _ ! ~ t i F~LED AND RECOROEDe 1 ! LllCiE ~OUNTY, FLA: ~ ~ - ;.~~^pr~~ ~ CI~Y A~ .*~A~~x~.N,.t. ~ ' . ~R,F,ED ` ~ _ • ~a~1a~ C:.-'``Pi~Ir.D rCt`~R)Ct`'~: . _ ; - ~ ~ . i ~z. ~ . '79 APR 2 PN 12 : 36 - ~ ~ - ' a~;~ rr--, i:- € ' ~j~~ . DATE 2 . ~~F~;',,~~~.~.`-~4`: _ j . /;l~iV~~l~, ~~~1?~MJ . ~ ..Y~.~ . ; : .CL~RK CIRCi1tF COURT ~ ~F - • . - . ;a.~:-~%T ~~~7~c: _-__.s_..~~..r t os~ph - ~tai cn, Ci ty C? erk ; ~ ~ € ~ ~ ~ ~ r~..V'~ ~ ; ~e} • ~