HomeMy WebLinkAbout2553 . {
t~
i
~p ~ / ~
4~~~ lt22034126
f
Tklt be- ~ aTAT[ aoAwo o. IlttwLTII CERTIFICATE OF DEATH
eewe• a aUR[AY QI VITAL aTAT1aTICa ETATEi IILt~NO:
l.sal rte_ FLORIDA
erg ekew el N R[GIaTRARI•R NO.
, r o, . r 1 T 1 KAC[ 0/ t![ATN GOD[ NO. 2. II1i11A1 Rf1f1R[M6Y (Rfw e.nrd twt t!.w.wr,« R..J«r IM•..Lwr.! ,
w e e r t. t t OOYNTY t. STATE li COUNTr
awe •111 St. Lucie 66-YXX Florida SL. Lucie
be ,laeel
Iw der- CITI/, TOIIN.OR L,OCATgtI t. K PIfIC[ Ot pEATII t. CITr, TOMIN, OR LOCATION t K RIS~OENC[ ,
a.w.wt Ft. Pierce INSIDE cOr u~T,~T • ~ I rtsQlTr~r .
r 1 1 t. U"J Ft Pierce '
IuME Olr (!J wet b Mgiftt,,ie etreN t/heetl 1. STREET ADORtSS
HOSPITAL OR
wsTITUTR)11 ~ p Ft Pierce Blvd 66 N Ft Pierce 91vd.
~ RIArt N Fbet xittrt taer ? OAT[ xu• Lt, )i0
(71«~Miap FRED F. 'r.'FISS o°[~A*N June .i 967
S[X ~ COLOR OR RACE T MARRIED NEr[R MARRIED ~ OAT[ Oi a1RTN ! AGE IIa N 1f~0eR / rEAR t)rpEA H WS
last Aaft~~,~ Af«et,. M~ Mw•. .Y..
r 1 s . N W unlxlrr[o0 OIr011CED April 16, 1865 SZ
, l Ua l t IOt. USUAL OCCt1t'ATION (Qiet fiat ytrMt tqt IOA KIND OF WSuOSSOR NIDUSTRr I1 RN1TN!•U?CE (9tft tr /brt+/a cwwfrp It GT4tM 0i ttIYT COI:MT•..
•1tk Per- • Ia.ily y atb[hk.e•eagrerLdl Y't USA
..w..t ~g~neer Plumbing Germany . r
?latt lwk 13. iATN[RS NAPE 1~ MOTHER'S MAIDEN NA>IIE
er ~
t,*..rlt.r Frederick Weiss Aulrusta Ulrich
SOCIAL SECURITr MO. V • MDIMTt/w[ At/rtu
088-03-937? F~:ilie Weiss Ft. Pierce, Florida
Tllwtral 11 ~AYf[ K KATIt [E'itfa tah eve eewe ytr rivet }r (e), (fil. tat (tl.j INTERVAL NETwE[+r
tlrttter ?ART 1. DEAT'N wAS CAUSED Nr~ CCrOn heart attack ONSET AIeD DEATw
¦Ilat the IMM[01AT[ CAUSE (eI ~y
tke eer-
•l ektatke ~Yitw/. i/ytRt. puE TO (k) - - . - - - - - - -
l o s a l aietr culee
ftt aN/rr-
f • 3 t \1 wr TY i/i~ nwt rail. OuE TO (el - - - - - - - -
{ \OYr{ a t- ~ PART N OTIwR SIf.I~RANI COROrttGtR WNTRNARRIG TO OCATN hJl Iql RIUT[D TO TIIE TERNOMI DIYASE COIpT10a 6Ma W PART 1(t) ~RiORMEp r
F
ter Nftk
I tr betere ~ rES? Np
IDe / t0s o[seRU>E hove uuuer aeeuRREO (Earn arr.r y laja., is Pt?t t « Put rJ yYra fa
k aakiw~ awl ~ ACCIpENT SUN:IDE NDMKNf[
~ O O Natural Causes
er - - - -
! ~ Zat TwE os Jretlr xw?. Dq. Yer
eed~, uuu+lr a. at.
g ~ 2et RUURr OCCURRED mt../MI[A~C.E
O~FMRWRr (t. r.. iw tr dwf ~wv. mJ clTr• TOMIN. OII LoCATgN 0611Nn sTAT[
I
oRK AT ~ metro ~ ~ f1Qla t~ rsA, trtt AIIt.. tEt•) Fort Pierce, St. Lu de, Fls.
tl / attended tM Ateeaaed
L/ro~a~l
~ Feb• ~ 9 , to Mar • and ra•t a•a. A/~ arire on - -
Death oeeurrW of ~f -~7 g'.,~,8em on erle date elated atro•e; and to tAe l+tt of m~ Ano+•pd/e, leorrl tAe uutet erteed
¢ All stews ~ NOt1ATYw[ (lNpee M t44? 22D AOOIlEiS 72t DATE SK.wEO
i ~ t.e • 111. S. 1Lrner M. D. 1122 Ora-lie Ave . _ 6-29-67
tccrrate. ~ CRtNATION. ~ PATE 2k NAPE Of
CEM[T[Rr OR CR[YATORr 27/ LOCATg1t IC1f,. Etow. M lMtwf,l (STtfti
RE/IO•Al (Syttl 1
g Burialh 6- 0-67 LHillcrest Mem. Gdns. Ft. Pierce, Florida
? . S . f e 12 t1 iGA1ERAl E OR s SIGNATURE Dt~~S 7th • - t • 2S DATE RECD. 1r LocAL REG. T6. R[GKTRAR-S SIGNATURE
R.•.196e1 KiltOn W. Baird, Ft. Pierce, Fla. ?-6-67 Anna Lee DeniQota, d.r.
i,
z
-
I (1ere0y Oartrt'~/ tt11s b ba • true and cornA copy O# ttfe Loup ~ ~ -
= Ragisttsr's record on Elie in the St. ludo County Hwhh span' ~~,Apd~leyA K
t fllent at Fort Pierce, f'brfda. i~~v1~r ~ `3 1 1 : '
~ ,
~ y ~ ~
(Wsrnirq: Not valid Irnlass reined seel of the St. LucN i579 ~u~ ~ $ 2~ r3~ ~ ~ - ~
County Health Department is affixed.)
LEO Ah0 FtCUK?~i0 - `f
~ ~ ~.LUCIE CQUNTY,F~,A. - _
N. D. MILLER. M. D. ~aERK
C
RCUIT C A RT ~ - , r ~ i
County Health Officer a t+otr Rpwtrel r~ ' ~ • : a-lG . .
RECOROYERIF;~C~ - ''•y°;~:'`~',-~=
F ~ Date l,oul Reoiclr„? .
3~~~310 PACE2551
-