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'y'~~'"^'' 44~'~.~ERTIfICATE Of DEATH "Ai""`"° -
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T rtf pfCtDENT-NJ1ME IIKI MIOOII LAST Sfa DA7! OI DI AIN rY.., O•., I •.1 -
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„t,,,;,,~, Whit Bevis _ :Male ~April__12~_1979
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White _ 89 ' ' .Jan. 23,1890 T.Indian_River _
CITi, 1pYM/ Of IOUTION Of OfA1N IOS?IiAI Ot OTN!! INSr11y11ya-NS.r /J• w r wM•, p.. c•..1 rI .~1r1 If Npy. p Irdl. IlMrsb DW,
» Vero Beach T. Indian River Memo_rial_Hoa ital_ _ ?a
In~atient__
' 1 STAY Of E.tTNI// 1• CIrITEN Of 1NIUl C01IIrtt MAtlIfD, NFVEf YAtt1ID. SINVIVING S/01AE /q wrr
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USUAI.tslDE/ltt Florida U.S.A. 1•-Married Ir_ Annie Mae Lee
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`.,s'1""/°"'`I"E 262- 0-84 _ State Inspector _ FYuit _
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~?/ISSOi! tISWENCE-dlAi! CONNiV CITY, IOYYN 01 l0C/ITION itEET ANO M1Mttt 1.1110E Clt? 11Y1tS
1..~'lorida St. Lucie Ik. Ft. Pierce 1.d24b2 Oleander Ave. 1.. es
fAIIRt-+IAtlf fltSi 111001E LAST ~ 1Wt-WIDEN NAY( flKi MIOOIE IASt-
IS- Franklin Bevis 1.. Emily Dixon - '
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INTOtWMJJAME /TTM r f•,•rI IIING ADORt35 STtf[T Ot E i D NO UTi' Of iOWN STATE 2N ,
IT..Annie Mae Bevis 17,2402 Oleander Ave., Ft. Pierce Florida
tiltlAl, CEFWTON, t[MOVAI, OTNE! /S~rr././ CEME V Ot CtFWI IOCAt1pN CIT1/ Ot IOWN STAiE
T. `~ascom °~]`e~iodist Church r Bascom(Jackson Co.) Fla.
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Off `"""A` Roger L. Byrd Port St. Lucie Funeral Home
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DAIE SIGNED IHa.. . )..I IIOUf = OE/ITN ~ ~ DATE LGNfD /Y.., Oas, tr./ IID1A Ds OEA/N
~ mil 18 19~Q " 10:30 P.M . f. ~ s_ n/a _ n a y
s~ NAME Of AITFNDING fMSICIAN If Oil/[t t11AH CEl11f1[t /ry1. r 1..u/ j t+ /t0•g1TTKt0 DEAD IY._ Or., T../ ?tONOUNC(O DEAD /B-,I
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NAME AND AOOtFSS Of CEtllf lff IrNt51C1AN, YEDKAI E1U0/1Nfry /T7N r 1r..v/
~ n Ferdinand F. Becker M.D. 8 Ro Palm. Blvd. Vero Beach
• tFGr•SttAt D DATE tfCErv[D t? tFGIStUt /Ya., !b. r..y
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.~w~p1 GAVE
~.~.=a F ~ Adult Respiratory Distress Syndrome
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}*AtING Tlrt EArt 10, a As A COl6fOUfNC[ a: - - , Iwbnd e.+......•..1 aad s.aw
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Sepsis, Pulmonary, Post-op ;
~ 011E TO, p AS A CONSEOUENCt Oi= ' I,wnol b...aw a,1NI aM dta6
E ~ a Nodular Malignant Melanoma Left Cheekwel ~
~ tAtT OTNFt SIGTIIfICA1E1 CONDITIp.4-Lr.Mrns u.+r8.=r.y b bod• 1..~ .w n4Nd b rwv ,..en r~ IAEI 1 MI AUiOK1 /S/«•Ir WAS CASE tf iFHFD 10 MEbCAI
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c 1?•eloWrl KCIDFNt. SUKIOE r DATE Oi tNAitV /Y.~ Or, T..I /MhN OF INAHY OE SCtI\E IOW IN11ttY OCalttfD
IOMKIOE. r IINDfiEEMINED /51rr•/.I _
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INAIfY At WOEt /SN../. In fIACE Of INAI•Y-At I.aw., /a•w, saae+, .+r•a•r, aX,r. M•Id••t, lOCA110N - STtEli Ot t.f.0. Hs.. UTV Ot iOWN STAEE
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"I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE LOCAL
REGISTRAR'S RECORD ON FIEL IN THE INDIAN RIVER COUNTY HEALTH UNIT AT -
= VERO BEACH, FLORIDA
.
THIS IS NOT '~~',tX+l1,ESS THE RAISED SEAL OF THE C}
INDIAN RIV' COIINT~Y`.""_FI~ALTH UNIT IS AFFIXED. \L~
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- CUNT HE H D RECT R, EGIST R
~ / ~ • - ~ I9?9 KAY -8 PM I= 16
"
~•t ftLEO AMQ RECORD~O
% . Stlucif Cpp~~NTY.F``A. EPUTY REGI~T$AR
" ROGER POIi'RAS
• - CLERK CIRCWT T
- RECORD VER~FiED
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