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OKt/?iEO-NAME •m• rrMe t•ft StR GATE OE OEAtN • rvN•M~°•t. fr.• 1
TYPE OiR PRINT
PERMANENT ' CLIFTON G. MacGREGOR T. Male Aril 10, 1978
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f White 72 ,~lov. 30 ,1905 Martin _i
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Stuart - ,4 yes „t4artin Memorial Hospital _}(i
S1AiE p k,MMM t r rot w •.f.•., wrt C1TtIEN p WHAT COUMTRr MAIiR1ED. NEVER HARMED. SIMViVNO SrOVSE 1~1
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utY•r Nfwrct , Massachuse`~ts USA ~arrleCl Jeann_e_Gordon ;
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,Ntr.M~.•eM „026-12-2981A p„. Manufacturer's Rep. ~ Restaurant F.q p^_
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,N Ohio ,.Lorain ,,,Columbia Station ,w ,N23798 Royalton Ro~
IAiMER-NAME htll rroou t•N MOTHER-HAR)EN NAME rrMt rroaf r•fr
„ Guy MacGregor Unobtainable
IrMORMIWi-NAA1E MARVtCi w00RESS ruNtr w f-•-o. r°., cw. M qvr., ?ur, w1
„Corrigan Funeral Home „147-68 Lorain Ave., Cleveland, Ohio
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CERTMICATIpt-HEDKAI EIAMRiER OR DRONER: or rwf Muf ar rot wow p tr1w1 rrf Neea«r .•f .reto N•°
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~ CERTAIER-NAME ttrrt 01 rfwn 1(',r/AT etoNf Of nn, bAFf SIG+iEDiwtrnw,
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David MacMillan,- M.D. CG L MfD. ~1 4/1l._ 78
MwRMKr ADDRESS-CEREY[R Fran a f r o rw - ~m oa W..t sr•n nr
t 416 Balboa Stuart FLa. 33494
r tiURIM, (.fEMAT1pN, REMOVAL tMETERY OR t.REMATORr-NAME LOCATION Can M r0..•. sun
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,tf Cremation iu. Necron Cremato_r_y. r« West Palm Deach, _Florida
1 k)AiE - trwr», nui WNERAI NOME-NAME AND ADEMESS ~ fmPpf f r.°. rr0 . c.n or to»r, sran, arr.
Ttt P 1 12, 1978 has Funeral Home 961 Colorado Ave. Stuart,Fla.33
VS. #6T2 f •ttRwECTOR- REGISTRA S?GNAi{/RE ogre ltCnrfo n tocAt Nenruf
I hereby certify this to be a true and correct
~ copy of the Local Registrar's record on file in
the Martin County Health Department in Stuart,
• •Florida. -
_ _ (Warning: Not valid unless raised seal of Lhe
- ~ Martin County Health Department is affixed.) }
~ _
~ ~ - t= Archie McCallister, M.D. I
- - County Health Officer & Loea1 Registrar
- - ~ - ~ _ r. ~
- ,
Date Uaputy ,goal RagisL•rar • ~
- ,
r ~ FILED nND RECORDED".
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