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HomeMy WebLinkAbout0123 + • i ~ - . . , ~ ~ , , ~10~L1 ~ ~ • ~ ~298 .~1. ~_.t~~~~ 5,.~ 919382 a . . ; ~ . . 1 - " . . . . ' i. , f - j ' - . j ~ H EALT~ DEPARTMENT ; ; 514 EAST GRACE STREET : ENGIEWOOD ANNEX PtlIVTA GORDA, FLORIOA 33950 ~ PHONE: 470-3249 PHONE: 639-1181 ~ ~ ~o: ~erai~? a ` . ~a na~a~a~~ ~Y a~'a'~ a f bau,ne,~ ,N~ ~ ,~,~tl,s~,a~, ~ ~ state ot ~~~or~cia CERTIFICATE OF DEATH ~ U~~partment ot Health and Rehabilit~tive S. rvices ~iATE r~~c r+o. ; VITAL STATI~'C1CS F L O R I D R REGIiTl1A11 3 Ho G~ -/Sl Sr OK ?DtO-HUM! • .•oou SEt DA7I W OfAtN ra w~. o•• ~ ,ct PF~~r~T ~ ~~y , Jorothy b111s Mitchell ~:Fe:aale Decen~er l,S;Q ~ i?!~1ANENT - - - - - - - - - ~ . AC K INK uCE ~t r~o~o. ...~a:.+ ,r~.~. =~GE - ~ ..s. ~wt• ~ ,t.~ _ ~w~~ ~ CAIE Of ~1tM , ~O+*r, o~r. .COUNi~ W 01ATN IK ~ f?lU~r ~ 1~~:. -..un• . T Iu ~ ~ ~ihi~e y .p••• ; ~ ,Nov. 4~ 1912 Charlotte U1V. iCiwt: O~ lOCA1~7ti Oi pfAIH - - . iro~ ~~n i..~n MpSHTwI q O~Mf~ NSTRUTIpN- v4M( ~.~o• ~r+u o~+~ ~~~en ..e .u..~e~ j 7 .~a ~ Port Ch.~rlot+.e 'iE~; N Faxcett lienoria2 Huspital , St~t[ Or M*1N ~u• _ ti..«•-~ iC~T~lE?a O~ wr,ut COt~+t~~ MAtl1E0 nE~ER ~u~bEO - ?SIAVnNG S~'OUSt W:~e c:.~ r.~a~ »..u co:,~r.., l tw wEO. D~ wcr. ~ j , , Zr.diana G.S.A. !„`~at~e~ „ James K. t~:itcr,ell ' ~ - - - w SOCirI SfC~.fi7t ?+U~[r tU3u~t OCCWI~t~Or+ .~..o or .wa oe..i o~a..c ..cu u. t ~tl?+O O~ WS~ESS O~ ~?O~Kft~ . . .c~¦~w .•q. nn. n~•~eo - I ~ ~ ,J 29`~-12-072~ ;,y he~ister~i. t~urse i„ _ ~•eciicine ~ ; - ' - - - - - - - ! ",ai.ei un ~~.~n ST~EET nnD ~+UirlE~ - ~tS~UE~aCE -S~~%E C«VNT~ ZC~t~, 7Avvw. OR IOC~T~ v~u.. .~e o~ .o ~ ,y Florida ,y S~.-a:sata t:orth Port i Yes I Fleetxcod Coa /ATME! -NAME .n~~ ~•oa~ ~U ' MOTNE~-MA~DEN N~A4f ~ns. ...eo.~ ,.s• i' „ Albion :~ay :•'llis Mad N!'.N Parris~^ IN/ORMANI-HAAQ MA[!K'i A~RESS is~ul~ W~~ O ~+O .(~n W'ur.., l~~M. !r~ ~h Jaines R. Aiitchell 313 FleetKOOd Court North Port Fla ` . IAtT I OEAfh WAS CAUSEC lY ~ENt[! ONt1l C3?~ CAUSE IE~ tNE /0~ ~01. AI. wND l~l! ~~MaM oNS~r ...e a.r. N - ---------rre.~n tavsi , i~~ ~ ~C '~l_A- . t ~ ~4./ il «-O'7• . • . Zd~' ~ ~ ~ ~ rw t o :i iiw w - 1~1 - - r, - - - - ~rwM~~~ C~YH W~, o:~ ro. w~s .-~o.:uow..n o~ ' ~t~ur0 ~r~ v»~p- ~ ~ ~ r C.~ ~ - ' - - ~AR/ ~ OM~ 11GNMICAlIi COr~O1T10HS co..M~w~ COM~W~rf~y(~ [O W~PI NN MO~ MV~tO t0 C~YM 4~~fM w. ru. ~,ai ~~.r~n r~..o~..cs i~- ~1 ~M N/H~ti1Mo-~1~r ~ a1-0llTM w 71?--~ ~~c~slJ~i~ w~~~UtlF/ -~.o..•-w, o~~..~u~ Npw IN/U~r OCCUReEO ' ~MU ...tvM w ~ ?rtitt¢l~.~r ~e. ' 0. O~ 11~0(itwW~ ' ~ ~ tw ~ M~ 7Y r .'J ~ v iNAM~ Ai w0~ ~IwCE d ~+Alh' .o.~. ~.wr, ..ee~.. ~wnON ~ sna~ w ~ • e .ro . an m .o~... s~.n : ~p i ~ wan n~ o~ ..o ~ pwK~ MYG . ~K ~ snc~n ~ i ' s w ~ ~ CERIilU110N- .w.~m .~u ~ .a.w~ - o.. .tu ~«o us~ s/~rr w~a~.w~ .~M or ~ ~~M~~..r. rw Ot~tM OCCyyfo •r .+t .uc~. a. ! ~M1NCI~M: n / rd+M f RY ~OOt wl~f~ Ol~M . wD~! o.n. ...o t0 tM~ ~t ~ •.~M~NN rM ( /y _ 7X W r~ ~~.o~r~~o4e. ~ ~ MC~~lfO ~~0~ .J _ / V /f/ ~ / V f ~ ~ 1~~ . ~H M IO h! C~VS~~1' S~~r~~ ~ CNt~fICJ?TiON-rED~CAt EtA~?~E~ O~ LOlOt~E~ w•.~ u~,: o~ ~•.i wwr~ w a.w. -~~~e e~e~«• •w.~ou~.ceo c~.o ~ ~WM~'~OM W ~M WC~ ~MO'J/ ~w~ :wrff~I'.~r.pM ~r~ ..r Clr~.rj: ~OwfM O~f •f~1 . .~OV~ E ~ Ol~M OC(Y~MP Uw M O~n ~MD oJ1 '~M ~~LSl~1~ 5~~~lp % - / , ' ` ?L . __~.h_ ~r ' - - - - - - CEfT1i1ER-NAM[ :nn o~ n.-.~, 4 ~ ~toMS • e 6~ .r.• ~ Jose~h ~o~inL M.D. ,r„ Rf l~~ - - - u_~~.?~~. ,r.en-w . o ~~~i ~o-~ • ~,.w ,f,. t wu?II~K', ~DO~f F ~y 7 $ ,tnc n CREw~~10?a. RFMO'~At tCGafiER~ O~ lRfMI~TORr _ 1(?CI~T10N c~n d ro... s~~~~ f € Ci~ematic:~ 'r.o*;~ I~ or Funera~ls _ . Lar~o Florida ~ .?wTE ~.on*.. o.•. f ~~~ht~~i NOriE •unrE •r~C ADDf[SS sr~~u o .•o . r*. o~ +o+~•.. ~~.•e in ~ ~ • ::o~:e cor F 13~'S5 rElcher Rd. ~Las o F'la ' ~ . -=t. l2 t.^a~t! D p -S 4!1;11f.~ . . - ttG !4!- S~'.+ ? ' ~ Dw ttCErvtO ~r / u RWN~u € . • , ' '~'.r - - . ; . ' / 7 T i , ~ ~ i - I hereby certify the above to be a true and correct copy of the Local Registrar's record on file in Ft,e Charlatte County Health Department at Punta Gorda, Florida. (W.~rning: Not valid unle~~`t~i~ ~ea~ ~f~the Charlotte County Health Department is affixed. ) ~cV fl D ~ ~ . LZ'C~~ " _ •~T - 1 „ ~ U,. Y. fLA. v :~~,~*'.i,~ ~ "~r -j ~ i- cn J A ~ y f'. - • .i-~rVAi f ~ ~ .'~•s, • . - _ ~ ~ 1 ~ :~19 r:APR I 7 PM ~ 2 ' ~ ; ^ . S~ County Health Office an al Reqistrar ~ ~ ;~~r~.:- AI' ' Rt?:: ~ ?i • c ; ~ s ~ , • , i ~ a : - J _ ' ~ ~ / ~C.~' ~ ~l. ~ ~`r' ~ _ : . ~ ~z~$ ~c ~.l~o Date` ~~G. Deputy Local gf strar . ~ : ,-.,r ~ ~~~.~7 ,a~~ ~ ~ ~ S i,--~-- , - , ' ~ _ ~ _ _