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HomeMy WebLinkAbout2793 st.t~ of Florida CEF~TIFrICATE OF DEATH Mpartmont of Health and RehabilitatlTrte t3anrictrt trt~t~ ?I~a No . FLOR A 41 ~ w~olaTwww • No VITAL e't'ATltsTtCti ~ ANO--NAM .•N•1 ••t { ID• t O w N • rl•». •1•t• TYIE ON /AINt ~~,O~u L~ ?AR.C~NS ~ 1 41r0.~~ 1 J~ y 12, 1978 t?ACK INK uhf .r•'n, ge1e. •NM•w .we.•r•, A01 -••a r.N• • i 41 4v.•~1~ ~~•~1t d N!iN ~.orrr COuNn M OfAtN t@ . MIt N/ . I •.•1•Nt . •1••Ir .01 ~ M•t wtlrtl ~ w N•• r 1 b~_ ~i» I ,~.t,e 20 191 S St. Lu~.~c ' tlbnZ Tb-rn+. ai ?~A1.~N-~ aiirli ~ ~''•tyt t•w .~.'rTtN~fiA? Si3fit{ wfTTLT - .m. ,i.•nt .•ilt• ..1 .r.iN r II Mltu/ r11 M /N ~ - ~ F.t. P~.ence I,,- yea ,1 Laa*~cuood ,Wecli.ca.C C.enteh _ _ _ _ ' • t aiM~N.u .el t • . '•••1 1 1 iMbi~?w?t C01Mtii7 ,?vu~d!/o. ?+tvU trc/Aiweo '>,w'vnr.o troufl e..1 , • ttlO..n•.~ } w~N tra/(/t.(.QLl D . vlt.. r r.r.1 .Itl1••t. { Web~t V.F/~g.in~,a _ t GSA • _ - 11 VUcg.i.,t~.a Sto~ie - - .+In Nu•wt f~[iu ~IZYMTi Nw•ft1 yi<u/,? bt`.ty~Atlb?• eta •wt o~ .01• Ie••• {a•.• ww r ~au+0 d Wfy+llf M INOI•fut • 1• u N•/r• .et•r1/t •W, t•Ir tt•••N . «trNt. ~ 234-18-8110 p'tM~ ~ F~~•tg~ q/1•rY1rOM, Orr1 jl, 1~ fV~-~,-__-_-_-_._- ~M - 4MN•KI NNIN 'rl _ _ _ -T--~--~t1. - 1- w?,N C:~ .ni.N . f1 u+ » ril. • •t.•Itrow iifwlNC1- rA 1 CouMr - ~Cdt, tOwN, Ot ~pCATK1N at a rs~ ~--i? FLon.i.da f ,„St. Lucie Ft. Pence ,tt~Ca 70l bth St. M A N!{-NAW hql •U/ '.•O /tt{--WIMN NAMI •.•V •.twt "1• Ha/t,lari .mot Pa~l.a o ne ~ .4'•a/i y Et'~rt tc h e.P P It 1 , rAewO Aopetlf .tryn o• t we . are a ro.r. U•n. 1•r r V~ -i.nia Pafcaone ,,r. 701 S. 6th Set. f. , ?.i. r 1 gAt11 Mrwf CAYflt1 ft• 1/NTft oNlt Oro CAyf( Mt twt rot p~ AND h!; i tl.u.-o•INI .r•t N•r, lei LA~ct,~v•its ;.-•,./Jr ci/•res/ - ~ ~ ~ to+atre.l •1.1 ~ ..rrt. /r111j ~ 1?1 '/~..~/e K turn / ui / i ? - ' r re.Luf1 t•r11 ~tti/iTTiiiil~iT - - - - - I 11•ow• 1.1 .wt+~ •hwt+ t•eM up - -~Aytt7?S~ Tv r!S r1.• • .r•.r•t tOr tAtT r - OTINt flp/tdKA?tT CO?t01110Nf to.tr*es t0•IrMrA.•N ro N•r. w1 •.e/ Nu•w •o teal ••.w ••1. r wr ,.n o• ~r i r./n1 Nnu.r•+. t..•t ~ ~ e. t1•r• /~/tta.ar?tn lf,.d ~rJArrJ`J+ _D,c.ua~/~~ tile//, L.. Iw.it/~~~w _ _ _ .....M....n ..1. jf.N+• I/r- ~ 1,[ ..r•1., M/. •t•t 1 `T_.---__,. , /rr/t 1rrN M ,r.r.• . ?1~~ (y. N~ .NOM INtyt1 tX ('Ytt1O NpYK.01r Vt MNttitMNM• ~lL•Mt t1/ ~ ~ IM M , IM INArtt A~ IN •r r0+•. 1•M, •rMlt, ••ttMt. 10CAT1ON . Y•Nr N . / . r0 ta. e• ro.w. 1*N/ . i .IrIt.N n• I•e/ twat Iw,I/t .Wtr/•. >w - k Ctt?YKw11oN- ~ y/..u eN ..•.!e•o roe t. rr/ M•/w pttyul• rr1 ••.r•- Or r+/ IN/ ••Y ~tMr • •'•1 } .ertr ••r1, •r0 b tl1• ~ . •nIMNt M/ ~ rI 7p 1 f r ih• ' 71 ~7a ---ilt• r.• 1'~ M .O rw1 urN-~.4 ,nry. fl• NtlNlt /ter• 1 rw• ••t•• V M Mr. M N•rr ~ 1.1 tKINn• .•t ~•O••e•.K/t N•• irltiYrcATiblt-Mf~A1 ~1~JAR~-SN[. O+~-__---- fir. .r•. .n.• _ 1••.n1•/0. tM M fOM ?IIt/b •M •••••Irre••O•r, u• ~ p+~'e'r. + .1•N tittr•Ne Or eM t•N /••t M N Ir11 t•Nlnr Ir•N• M N4//1 a •.Irl M, t1••I tt 1 i/~/-~~ ~ ~«?i N i.•,n ~ 'T+2iNTyiT-~. - t>. 6A ••/ca/ do a /3 ~ /t ~/ND ~ A _ lJ~s4J~7_._C~•t .-~•~ic.tnl,,. 7/'.~ I-7. f ---t'~T~p(~ i ~ ip-- t7i pi ~8.+ .r.n 1+r Au~lrp ~Iooit - rt twt - . P t - t i 111 ` ~ , an o/ a... ,r•a ,v iMui CtINU? SON. rlu I ttt t w1A tt-NAAV , ! FTea.c~ia _ Bu/t~fa,C _ N ~n¢/a~t :hem Ga/.dene .1•r Ft. P.i_erce. - - _ € eiinJ~ ~ _.IN• yhtta N M M,•bD?~~ 1 +Y•1' t1.• P~~~.~ f~. 33450 y 1~ 1~t/~ Da,chlf ~uneica.[ rsnme, X09 ti. r~.t~: Sit. , l , ' ~ W - . t ••1 N •Ot tIq•pIH ~,,,,ttw tlOrf - - tar•lutf ~ ~ - ~ li ~ ~ iF' ' t/ t:l 18 1978 r `t 1 hereby certify this to l» • true end corrsn c°VHw t" 1° `09 N;IY ~ 7 A1~ i~ VD Repistr•r's record on file in the St. Lucie County tl'lenf •t Fort Prerce, Fiorid•. i f3 ~ fit. ~f11~0 ijVY•rn;°g; Not valid unless raiftTd teal of the St. tuc1~ ~`A, County Health pep•rtm•nt if •ffixsd.) fib t REt~RRt 1':'RIFIEU N. D. MIIIER, M. O. ^ A ~~L Count H hh Officer i toclal ReQLtret `!•3 V ti ~ DrPt+tY loc•1 Rpistrrr O.b - s ~OGr 3U0•'ACE 1 ~ _ _