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In re: Lot 4, Block S, EMANCIPATION PARK, according to the
plat thereof recorded in Plat Book 1, page 38 of the
public records of St. Lucie County„ Florida.
T.dcd s.etult)rAx•aer ~ GE08GtIA DEP~RTNff.NT OF PgBLIC I~ffAI.TB
~ ~x«~ S'^;°' C~ERTff'ICAi'E OF DFJ~i?H
sla. rst. )a.-
•
sans ta. Dssa. Dial. x.. - - ~d.dl..•. x..
I. ?saes d Dwtb L bawl laida.ea (M1rx• daeaaaad litrad. N LitWlMian s.~aar_
ta) Coati ::Ot2lR t 011 (a) slat. at • tb) C.a.tlr $01Z/tiC~t
CA7 K $1.~® a RY~ai~
i p~laea) Csf ~k0 AY t~Dla plat.) .
(b) s (e) ? w -
(tl Ot~tsida Cit7 w sows Limb. Add Tiaras) (L trida City oa fowls LDttib. Add =tad)
x...atNwp. R.F.D•w~Rural~ td) strati « t.t.D...a R.F.D. ~1
td) et leaitou.. Addraaa seat xe.
..cFi*,t) b. tleaai.) G cLw) opt Jam:
t K Prr+ 8 a Burs~lu~ Dusts
s. sElc R 7. lIAIUItED, xEVtai tvAalilm A N xa:a.a ar wiaaw.a ci.. x... as sp..a. . AaE ttR aan t)xDE[t ! W vrtDEa 11 Nii.
ld/t3o ~T~giaO ~rvolicED taweu7 L.B. BuIrAt11 7) D(aatYs D.7s Henn Dsa?
It)a. t)sIIAL OCCtiPAT10x tch. khd at work Ittb. ET3fD of itt>sutESS OA )II• Il. ilisslN~~LiC6 t «tepga cowtr=) 12. c_fTlgN Ot 1R1RT • .
IAb'0 ta..t d waddp wa ii raKr•d) Dt1s'raY ZiO1t8Ct~n . Go. p ~i?. U
10. tAT~'6 xANE It. ItoT11ETt's wimEx xArrE
~ i'ennie Yaa Burner
TS. MIAs DECEAttED EVES III II. s. AR1dD FOSCEit iti. soc1AL sacitatTY ti0. ~~lfi.,,,I~~l``Q.~,~.O.~1..tllAll! • . _
tYM. our K •akMwa) (il Yaa. tl~ war or dabs ai aanieo) ' J./~MA'w OI • Ham ~
_ _
1L CAUSE Olf DEA'[!t 1f6DICAL CEZiTRICATIOx RITE[VAL sETWEEM
L~tasa~a)r (b)r ad te) I. Cesd3tioa or eewp)kat)ea OxSET AxD DEA'!>!
t
(a) diraetl7 iaadiy t. DaaW
Did casdiGao. tl a~7• td•LO - ~
(e) Oadarl7teO eaasa al daatb
. TT. osNEti s/axiFICAl1T coxnmoles
Ceaditiaaa eeatributiaQ b tD. death bas wt €
ralatad to tba disaua er eoaditiea ea d•alb
Ila. DAlE O! Old I Itt4. DLti101t tlxDitlas Ot OPEAI1TIOx AUTOPdYt
YES x0
Ctleied t Lda Z•Ea 11. ~ I L - I S. 6. 7.
=la. ACCiDExT tspaei[T) tlb. PLACE Ot IxIUl1Y ta.4•. la or shoat I Zle. (CITY Ol TOWx) (COI)xTY) tslATE)
~~i laeo, tars. iacterY. atroot, area bidq.. ale.) ~O1l~tiQQp
'i Yld. ~ Maaib) cDa7) (Yau) tlte.r) 21Wo~ix)UYY OCC ~ 211. NOW_D~LDwZaa,10>tY OCCIlI? .
Tx1Q~Y aw Werk ~ at WerD ~ llt~ ~iivY wOt~
I
4Z. 1 barabf aaetil7 that I atia?dad tha daeaaaod how •1! - to N - that I last saw lha docaaaod
i alltw I! - sad that doaeh ecearrad at ~ haw IDs lassos sad os tba dale abtad abeaa.
! 4]a. slaxATUIiE (DaYra. K titb) Zlb. ADDIIESS lie. DATE 61axED
J.B. Rhine Coro~ur par , tla. 1-$Q•b3
u.. sitlUli» Ca>~xk t4b. GATE ue. xADa of cLdsgY ptt cwrASOTiY ifld. T.ocATlOx eta ar iawi) (Cetmt7) ptato)
nox, AL tsp•a~) C rst = o R.F Nvt38touD ~a• i
-
KATE 1EC'D T+Y LO ~ aEa1sTE~a's siatu?TUaE 2'. tun[AL DnIaCTOa ADanaas
J.~. williems ,.fit: u
E ~tt~o. J.k. ~'t~d8i - :UCI~C~:'~Ut:TY. FLA~.~ a•
CESiitiED COtY ~ ~..t~:-fi~~
State ei Gaae'/la'~~'e''~'`;i t ~0~~
ca,+nt, at.,.~: , . ` f , '79 APR 16 PM 12 ' 0 3
I 16•ra~,~a11ba - j~d sad camel eep7 at a newel a W if this at6ea. I
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~ SEAL { ; .v- )
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aP[NCEw B. 41LD[RT. ATTORN[Y AT LAW, 220 [OUTM a[COND tiTR[[T. PORT rl[RCt. /LORIDA ~
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