HomeMy WebLinkAbout2882 • ~
Tels lTATt lOARD oR NtALTN CERTIFICATE OF DEATI~ , /
tows • [UREJIV or VITAL RATte'TICe F L O 8I D A Y7 tlrATt rlLt No.
lejal rae-
ord elaN •I T NO. R[QItT11Alt•e NO.
proper 1 f - C t NCI. t tIWAt 11[1tetMCt (IAw• dn.s..t 4wd JJ ~+w./.r.w~ Renlwu• w~ sdnw.w)
e c • t r t. d 1. ItAtt O/ eiATN e. STATE b. COUNTY
'na .111 0D1NTY •e G ~ lorida Broward
e• placed
l n per- CITY. TOIMN.OR 1OCATN)N t. K CE Oi OEATN t. CITY. TO1MN.O11 1pCA7KM1 t. K RESIDENCE
aanent INSIOE CITY LIMITST INSIDE CITY t1YlT3T
rll.. Fort Lauderdale TESm IIOp - Fort Lauderdale rES wj~_
d. NArE or (//ate is Aer~ital, Iirs at?tet adNat) t STREET AooRESS
NOSMTAL 011
wsTITUTION Hol Cross Hos ital 6323 N. E. 11th Avenue
14?Rtt e? FMat xwrt Lett 1. pAT[ xead Dy Yea
(nxMr+ao WILLIAM V~Ipp ROBERT CLIFFORD o~uTN January 8, 1969
. SEX ~ CO1+O11 OR RACE 7. MARRKDt1,p NEY[R MARRIED ? OAT[ Or •IRTN AC[ (la pray ~ IAIO[a 1 TtAR MIO[a N IsK
blt Oi?ddq) MwrAr Dew Xwn Ni+.
• r t t • ale Hhite wloonEOp DIVO1IC[D Nov. 23, 1$96
plaielp IOa: ~yµ~rATgR(CirtNwl./rMSdaRt IOS.KU1O0FWSIRESSORINDUSTRV i)- RIRTIVtAC[(Sldt.r/a?tfpRterrcrp) 1 . CJnsalOrwwlTDdwnlre
e l t h po r- dviy cwt N lvarlia/ hk. euR !/?dird)
••"•et Fireman Fire Department Washington, D. C. U.S.A.
Dlaek !ak 1~. fATNERi RAMS 11. MOTHER'S MARXN NAME
t~peerlter Geor a W. Clifford Sarah A. Padgett
) SOCIAL sctuMTY NQ. D. tM , SICNATURK wddrea V nu
577-40-1192 Esther M. Clifford Fort Lauderdale, Florida
funeral 1• tAllti ep OEATN (Earn ea/p eat twat 1" /e? a), (AI, aR (c1.j iNTE11vA1 IR:TNEEN
d 1 r • e t e r TART t DEATH •AS CAUS[O Rv~ ~ ~ ~y~ ONSET AND OEATN
¦ u s t E l l a wNEMATE CAUSE (a) jjJJ
tee eo?-
tirteata CyltdifteNa ~/qp•
eft. tie 1••• r OU[ TO (0)
1 e e • 1 alsst cswr
reslatrar etshy f4 rRdrr- O4E TO (t)
etthis T2 Z hl•p lalf.
O 1A,RT 11. pTlfll SK N1rICANT (,OROITKMri COM11dRlfY~r TO OtATN SIR NDt RELATED tNt tEtNYML pSU1SE tqN GIYU YI rYT t(a) SAS AUTO?SY
eoura at- ~ rERiORMEOt
ter deati YES® N0?
sr Oe!'ore ~ 1 ~ OESCRI INJURY OCCURRED (E rr astrrr a Ia w is Pat /r Pat I!• 4sss /l.)
raktat ae~ H ACCIDENT SUK:ID[ MOMKIDE / p /
dlepeat-
j etoe of
eodp• ~ ~ TIME Oi Hsar ApntA, U•p. Yta
iNJURr a. w.
i S f. aI.
IbI RUURY OCCURR[0 ZOt. rLACE Oi uUURY It. is sr crest Aos•t, teJ CITY. TOwN. 011 IOCATK7f1 COUNTY STATE
MNNJI AT ~ NDT ¦NIIE ~ I•r'w. J•dM1. shtct• o/Ict Dld/., Kr.)
•IOIIK AT s1011K
~ ~ ! etbnded eM deceased /rom . to and lest sar Aim aline on -
DeatA occurredat S: SS p. m on tAe data stated shore; and to the bast x m~ Anorled/e• /nom the causes stated.
?Il Maas eMATyN[ rrtarfYl~l n,. ?lh ADDRESS 72t. OA ESN: O
are to la /TY/J
atcu
~ 23e j~(as41. CREMATION. t]D OATE 23[ NAME CEMETERY OR CREII?TORY 23d LOCATNNt (Cltp, tai R. N ceaatp (.S7aft1
I Remo
afS~rl/p~ 1-10-1969 Suitland, Maryland
~ • • f e jd fUNERAI aRECTOII S SN;NATURE ADDRESS Baird-Case ~ OATE RECD RY LOCAL REG 26. REGISTRAR'S SN:NATURE
R•••I+aee L Ft. Lauderdale, Fla. 9 G
i
t
a
E
~ CERTIFIEn COPY
1
~ I hereby certify the above to be a true and correct copy of the Local
Registrarla record on file in the Broward County Health Department at
Fort Lauderdale, Florida.
(Warnings Not valid unless raised seal of the Broward County Health
- ~ .Department is affixed.) 1919 HtaY 17 PM pp
• ; .fly FILEO AMO ktcUkDe:O
' ~ ~ ~ ST.LUCiE COU.YiY.F`A.
~ T n~'
~c~/•' ~ ROGER POITR S
t ~ ~ ; x ; , CLERK CI IT ~ 4txh
Coun ealth Offi rand LocaDEReg~pnh~r
b
- - ~ s ~ _ ~~Q~ . ~ ~ 41443
..•r1w1 _ . '
1 ' Deputy Local Registrar Q
}
• f ~ f ~ 3~~! ~B raL:2~g~
•