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t.l• N- arAT[ aoruio a. Kw..w CERTIFICATE OF DEATH
a.N.. • au11tAY O<• 11RAL a'rAT1aTICa aTAn /Irt NQ
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•I••OS•fl ~ OOYMTY STATE 1. OOUttTY
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if s•r- s. eltr. TORN.OR It)CATIOM a. IS FLACE OF DEATN e. Crn. TORN. OR IACATKIM f. IS IIESIOENCE
¦•M•.e MISIOE CrtY LINITST NtS10E CITY LINITSI
til•. Mo ? e YES No
_ f, NAYS of •ft if E«~. tIM fCrffl •f)flrfAf) A STREET ADDRESS
NOSF/TAL OR
NISTITUTIOM
3 IiA1tN[ M lYrfi YI/tawr Leff 1. DATE alw0 D.F Ym
JOHAIJff~-A1IMFS PHILBIN ~T" December 11 1~
S. SE% L. ODIOM 011 FACE 7. tfAttRtEO~t IrtYER MARRI[O E. GATE OF MRTN AGE l!• /ctrl i uAAEl1 1 rtAA uAOEa tf IAIi
ltd AWyq) Ywltr Mw Rww Yi..
1 s• M W •IOO.E° olroRCED March 2' l syb 0
/sas•1s 10.. usuu Ottll?ATIOM (Otfr Na/NIfaA M•f 101. KNIDOF NtSNiESlOR wt%tsTRY 11. NRTNRACE (a)Atf a/Y?fyoM•bE) ) . Crtl>Tn CF.luT OalRATI
•1s\ ~.r- lwt•FAIfMywrttAlhlr.sellr/ryNrfA USA
¦¦¦••s Fit sneer Hotel Fall River Kass.
>tl••It iwt 1 . FATHER'S MANE 11. tfOTNEII'S MA10EN NAPE
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•sr••ri~•r Patrick ~ Unsbt.
IS. RAs DECEASED EVEN w u. s. AturEO taoRasf . soclAL sEtuRlTr Mo. q. s •IOMATt?N[ Florence L. Philbin
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092-07-41 9 A•+f« Ft. Piero or da
tslw.r•1 11. RAYK M wttl lilffn f•1/ fMr esM« /a JiMe pr (1). AaI (t).) (NrE11VAL tN:TREEN
ONSET AND oEAT"
air••s•* F"RT ` DEATH RASttutsE°.r' Broncheal. neudlonia 2 da-rs
•Mf11 rll• IMMEOUITE CAUSE _
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~trtaf.+i..~rf. ouE To (st Ca Colon Kith I?:etastasis ?
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\•.f • • r- ~ FART IL OTlfa Sifil/IrAMT OOI~R1016 Q?NMNRttMI• TO QATN ~ MDT REUITED TO ilt TrRY•IfL Df1AASE COIDITIOM CMEII M M\T 1(A) .RAs AUTO?SY
~ FERFORMEDT
tar Nat\~tr/ YES? NoEJ?
f ar Nrar• 1 OESgINNi 110M INRIRY OCCURRED. (rlatQ NAt•rr 1
¦•!i•i ••7 ~ ACCIDENT Su1C10E MOMNStR N •J•r1 b I r Pat 1/ ylrrw t1-)
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rri~. •r ~ >'Ar. TxuuR°i ~~if. KiAt~. DAr. Yfa
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ak. MUURY OOCUtd1E0 lat. RACE OF MWRY (t. -F-ss __1•~ a •Ewt MAIL. mf. C1Tll. TORN. OR lOGT10N OOYNTY STATE
MMN.E AT ~ MDT RNLI ~ IaNI. ftldMl. fbtd..~s My., fTt.)
RORK AT ROAR
k 21. I athndifd tM daow«Jhom ~ 1 X22 , to 12-11 _•nd /sat wf? 6/a stirs on 1 -
Daattl ooeurrad at ? P-M- w all tha d•H Atatad aeo.•; and to t)1.6AAt d fTa Ano~hdp. lrom tAfr tausM ftft•d.
All is•.a ~ (~«a~) ADDRESS Z?s. oATESwNEo
•r• tw 1•
~..*l.s.. Iaalt F. Watkins )!1. D. Ft. Pierce, Fla. 12-11,- ~6
aA•sr•s•.
r!A tMlRlfl. d suTloll ZA. DATE tlc. 11AME OF CEMETEIIY OR CREMATOKY 27/. toCATKNI (GVI. MrR. a cf•nfF) (~alr~
~emeva°~ 12-1 b -~\~s.a St. Charles Cemete Quosns Vill a h.Y.
@~ 7. a.lalt 2/. Fu1fERAL d DR'S SIGNATURE 1^-~--7th. St. J3. o11TE RECD- t11/ LOCAL REG. REGtSTRAR~s s1GMATURE
a•.. i.es )uilton W. Baird Ft. Pierce, Fla. 12-19-66 Anna Leo Lerli: en d .r.
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~ tlKaby osrtity thb to bs a tnN and oarract aoPY of MM i~ocol__.~- • 'COa~~~
Registrar's record on fits in the St. Lucia County Health ~Dapae~- •
rrlent at fort Pierce, Florida.
~1g1y
(Warning: Not valid unless raised seal of the Sf. luck
County Health Department is- affixed.) ' ~~i 3~
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• N. D. MIIIER. M. O. ~
County Health Officer ~ local Registrar i "
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o.+. oetwty Local Repict.RF •
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RETURN TQ: Home State Title Co. t~
-19 50 Lee R d . 50~K ~ ! oAC E
'.inter Fark, Fla. 32?~9
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