HomeMy WebLinkAbout2610 444542 ~
Stale of Florida CERTIFICATE OF DEATH
Department of Health and Rehabilitative Services srATE E*ILt No. _ -
VITAL STATISTICS FLORIDA 657
REGI6TRAR f NO
DECEASED-NAME •~tr r~oolt 1•sr SER DATE OE pEwM ~ ro«Iw, e•., .e•a ,
~YPE OR PRINT
?E RMANENT , .ToYln ~ 2. Male a N0~V0[1~e1" 25 1978
SLACK INK RACE rrm. «taw, aweKa« Iwsu«• AGE-I•sr w.aa I nu w/eea , M• LATE Of auTN Irprrw, w•, COUNIr OE DEATH
tle , s?u:.. ~ uerwoa• .•e•ts~ rot o.n Mows rt». •e.al
6602 63 Se x. R. Feb. 20 1915 „St. Lucie
CtTr, TOWN. OR IOCATICN Or DEATH u.set cn• asuss HpSr11Al OR OTHER RVSTRUTION-N Iu nos nrwea, cIn slpn are «wpt 1
sMt7n qs Oa rs0 ~
>e Fbrt Pierce Yes Iawnwood Medical Oenter }
STATE Or pRM i u wol 1« u s . , «•rt CIn2EN Or WHAT COIINTRr MARRIED, NEVER MARtlED, SURVIVRVG SPOUSE 1 u rut, oM r•qw «•rt ,
C011n1a•I w1DOWEQ~ a1WE,XE_ O~ srecr., Gloria Gt:ntile
nsa.Ict a Holland _ a j~ ,o. ~$r~l~Cl
-+ve oeU?st0
-IC N•>t1 SQClill S[C'1t,T/ Nt1WER USUAL OCCU/A1,pN IWe ar/0 0/ roes eont owwa toss or KIHp OE BUSINESS OR INDI,Srir
ccr,;IS/p M rOYr'Ifi uM, e•t« M phatOl
_ „D Gocttracting
N 150-03-2214 Qamler+cial Painter
•~-,,.o« uE S10ENCE-STATE COVNTr Crtr, TOWN OR lOCA110N wsuN cln srlltf STREET AND NtlMeER
L~~ lsrecm •es M rt)
r•A Florida ,.e St. Lucie ,k Fart Pi,el'+Oe ,b. Yes 1708 Rio Vista Drive
EATNER-NAME rlgt r10eae Ysr MOTHER-AIAbEN NAME rMSt rl0eat use
rS John - Gr' ,e. ~ JO)13I1I1a GQSritson VanderHoop
INEORM/WT-NAME MAIaJG ADDRESS Isrpn oa a.r.o. ro . em p qrn, seen. t1r,
Gloria Gr' 1708 Rio Vista Drive, Fort Pieroe, Florida
TART 1 DEATH WAS CwIISED 1r: IENTER ONIr ONE CAUSE IER lR~ r0R p~, (61 AND I4 ur• 1« u .
c n atrrltr Ons/tt~~.ne «.rw
lo) • «
~ ~
cowon,ors, n •r•,
rwKr aari Ufe q lrl
Ate" 4 L~vc~ - n~~~~ ~
IrrfOUrf e•I,sl Ia, yw r0, p •s • COrslOUtnet Or i
srwnwa rwe Ynaea-
I,Ire e.vp t.a Eel ct ~ ~ 4 2 Z ~
1ARi ¦ OTt1ER SIGNtTICANT CC>•aWT1QN5: corwnans ca.warvu.la a otrr aIn nos puree ro c•ost aMr w. rut I r1 ALROPSr EE rEi rear nrnwaa co~-
Ins oa wo/ YNaM In ane..«.ra ullsa
j M 04rw
~ ,y, tge
i p.~a?1~
Ap.~1~CCI~E A 1 roan, w•, rt•a, HOW INIURr OCCURRED I tuna wlwt or Irwe• .r nn 1 Oa ran u, In. u I
t10MKIDE; q V?OlIELM,NED
tll~l'1
70a 20D 20c. M. 200
INAMr AT WORR PuC Or RVJURr •r Wore. utr, srpn, raOOa•, IOCAl10N unea oa a.ro..io., an oa torn. sun .
~ 1 {Ie(Iq ns 01 n01 Orrice acoa . fK / arKM• 1
t
2CM 201 ~ 200
CERTIrKATeON- .Ionrw w• •eY rOrIM w. •eu •r0 use YI•e Op 1.~/ O/o rOS .nr M p(wM oeeuneo ar wx tact, or eIe
trot Mt •tY E~O• area Dtalw
1N•SK,wN: ~ ~wOW 1 Dan, •w0, b M pt• -
~ 1 •mnao r.c ! L ~ TO ( Q ro nN c'w~sai~ii:na
2ra O,Ct•st0 raOr \ 2,D ~ ~ 27c. \ V 2,0- 27• ~ I
CERTMICI?TION-MEOKAL El[AMINER Ot CORONER on Iwe t•sn Or 11! w a a.tw t+aceawr .•s raOrOVrCto a•o
¢ et•rw•np1• p r1lf aDfr •r0/q r11f w•IfrIG•rlor_ 11• plwtgw, rOwrr Wt r1a¦ Iw,le
i Ot•M O(cYtatD O« Illt aan an0 Wt r0 Iwt t•uSe ~s1 Sr•n0
~ 72a M
CERttRER- oJr w~ SIGN TUBE apt a not GATE SK,NED IrONrw, w•. nut
P 27a _ , 1 t~ - l~P V 23D 27c i 1 L ?S
MAaltG ADORE fR/Y ~ srplr O. lr O [ W s~~ hr i
~•OS Form St2. 2b
E ,4n, 1N? RURUI, CREMATION, REMOvwI CEA,ETEtr CREMATOtr-NAME LOCATION un w sor« n•
:.a_u OPGVS Isnclnl -
~61r 2.a Burial 2aD Fort PLe,Yne (;E'llletel~ 2k. FbL't Pierce Florida
DwTE 1 rOMw, M•, •IYI TUNERAI HOME-NAME ANO ADDRESS 1 snnr w . r o r10 , al. W ro.», s,•n, n? I'
?b 25a i 3450
EUN[t r REGI -11GNAr1gE care aece,.to t• IOC•1 nalsnu e
25DLG 26a ~D ~7
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nsreby CAftlty Mb t0 b~ • trEJe end t~orrest copy Of tt10
~istrer's record on file in the St. Ltx1Et County Heehh 9 t~AY I s ~ ~ $
en• at Fort Pierce, Florida.
FILED AttO hkCOEilii:0 -
(Warning: hot valid unless raised s~eil of tFl~ St. LtK:I~ STLUCIECCUHiY.FLA. - -
County HEtelth Depertment is efflxed.) k4Gf.R PQITRAS - ' ~ f
Iri£R~ ~tRCtHT Ca~g~J
€ RECORD 1'EP,tf'C^~ ~Z
N. D. MINER. M. 0.
County Health OffiCK i ~ocel Rpbtrsl 444542
i'~et1i i',ronl ReofH.ETr ~
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