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HomeMy WebLinkAbout2828 ~•~•j1i 7 t••,••1, Gt=I•t 1"IF IGATE OF DEATH nn pp Q U~par.ment of HeaUh and Rehsbil' li ' rvi s ~ sr~?T~Xit.7F~~i0 a~ ~er~ " o , FLOAIDA [~j~~~~Qr 4° VITAL S"CATISI'I(-. ~ ~ 4 5 715 RECr1EiTPAR S NO + sv ~ TYPE OR PRI DlCEwSED-NMat 1a+• +•0011 S[a Owt! 01 pUtrf • •c«.. e•., •t•a. 7N ~ _ Q~~ 1 1 t~Oi1~"7I? 1'~1 c F~brtt~ry h 1n'7$ PERMANEN -_-SAi • 1T-L - - - t-. t t t BLACK INK uCE ••1,1. r16a.r..r1a1c•.• .re~.... ~cE ..fr 0..01._1 .f.a ~»on- a.. ~CA1E W ~!n?f ..0«•1., e.., {~OV?~tr OI pl.M Irc 1 a•1 1r• r a~ar.0 rf•af' rpa r-O•ra wdNf T-- w 1.. 1 ~ _'~'{iite _ I,,_ ~'eb, f~, IF#~6 ?rc~~~~.~rci CttV, TOwN, OR IOC~riON O( OEwIN •~f~e1 un 1r1rs ffOSt'rUl C1t Ot?fIt lISt11UT1ON-•1ay1! •.o• nr..1a w+1 1nn• ..ro rYran' Hol_lyT'~!~ad _ _ _ Yes ~-~lfcrt:st itursn~ '{ome _ z• ~ S1AlE CN r1~lf1 ..r ror 1r u f « +IrCIt11EN Ofl NHAT COVNlRY MAr R1E0. NEvE~ MAtr1E0 ~SVOV1vrK, SPOVSE 1.r .•w c..1 r..o1.. wr1 1 cowra.l w100wE0. D1vORCEO 1 vlcrr l -f~~., .f alWrcl E1•:ar land , l1SA tr ','ido~•~ed cif - hone ..11f oue•xe ~ - - - - - - - 1. - - - - .,.lo r ot•n1 SCK1w: SEC7R114 NUMlEt USWI OCCU?At1CIN lwva ar.0 or +paa Dort sual»c roar or #rtlNp 01 W51NES5 00 1NDUSTtr ?U ~aatp vw 'rt. htr Unafe r 1 - -.11~•Y.wr.cm „2Ei~F-~~-16~~ ,y1tE'C~iC£!~ i)7CtOr l,» i'PC~1Cr'i1 ~ rn'cerce uwu _ _ _ _ _ •c.~ls~or 4 1.isf c.n 1w.n STiEEt` wifp NUM{EO - - - tESU)ENCE-StAIE COVr+tr Cttr, tOwN, O~ lOCw1tON Florida 13ro~-=ard Ih11 ~•1~nd Y i11, ti'e:, 301)1 Sa ~ce~~ Ur. tA1Mlr-NwA1! rlaar - r.Opf f•ar M011ft~-MwIDtN NIMt rufr +.00:1 •~r 11 ?`orris Hoclki.n Ala '3ricker INlpUNANT-NAME AaARIN(i AODOE SI liner oa a.r a .ro . ur. W . r•n. f.a1 or«. a Fredric J. ~iodkin- 264 Scott St. 'i~~.lyz:o~d, Fla. PArT 7 oEwni wws CAUSED Jr tEN?E~ ON!?aONt CLAUSE ff0 IiNE fog 107. 1e,. •ND ta71 n .ie. u1 a. r.re..n y1 64TRS~IbrxOV1 t _ L/7 coroa•ows, 1f •wr rV ~wKw 0..1 a1f1 r0 t~7 Irrleutl C•vf1 ter, e,rl rO. W •-C01axOY1.K~ p - at•11ro tra YNeaa- inr0 Uuft uH =On 1• ~ (Q 2.V ~~~...777 /AtT OTNEr SIGHUICANI COND1iK1N1 cowano,s co.a...Yf...o ro m.f. wf wor awrlo ro uw1 c'.a•..+ ••n . D1 O A11t0~ Y tt vlat .•«o'rca cc - 1//~ rn .,IS o•~ f.o(~/ 1r wnwlrlwc u1,. ~ ~ ~ / i i~ , r ~ ?'M~' ~ ,i,~1~ J~(ili..L,•.G ~ 1 C'r. ~ r/ * pe•sw t Wa?e! ! iCC~M4T, yUKip[ Ot AT€ IN, ' 1 ro»r», 0••..1•.r NOw IN1U><a' OCCUI~lD 11..+1.i.+rfa1 Or 1.1r1i n...ar~pa ..ar u, mr 1a 1 ! IIOMK#. O! VaDlIUMw[D % r Ity, --t E ~ rw 701 M tot ~ ~ IN1Urr AT w001( PUCE Ot fNr1R~ row. 1•ar. srnlr, r•('rOa•, LOCATION , a*nn oa . r D ro . un oa roivi, ir•n . ~ r-j . ' 1 fRC1n of Oa .101 OrrK1 MoG , IK I trf(.n 1 _ r i Lr Ira 7p ~1 i CEON1CAt1pN- rorrr e.. .ua .ore. o.r .1.¦ •ro us• s•• • •»n .n.1 or . oro ro.o .r_t .ar •••e o oeew¦ o +r, •u(f. o. ••1 I ~MtSIC1.N ror•r O•. r1.1 100• ••r1¦ Or it i•OUa• n O•rf, •.10, ro ••.1 r •n,roso rr1 ~ / - 10 ~l 1 1 Dr r. a•ro•.ut,Gr c 7fa 01u.afo raor ~f 1711 ~ ~~~?,l +fll ~ _ l su .•2 P.l'- : 1~M •o •r1 uuxsl sr•'1- - CEOTUiCwT,pr/-eaED1CAl EawM1NtR Of CCNONE~ or r.f 1.s.i o• r.a roue o• ei... i r 1o1c1 r• .•s •aorource; ee•e aa•r.r.r,o.. M r•f ap0• •rOl Oa r., 'r.f f. r.. -10w. r• O.r..Or, j ~~r0•.rr ~ rt•a +Or• - - _ ea•rr OCC YaalO O'. MI D•rl •rD D'R r0 •.1 C•va1~i~ ~i••r1e ~ a !!a M ,11? CEfTlilfr-NAME lnrf o. •a>rr - -~iGNATUtE - / ~~icn1 c. •,,r O~rE S~c++f0 a:•..1.. z>. i'•~r-t.ln •~rPS hr'r, 1•`. 111 " L= •y-~''~? 1111 t~ MAi11Nc ADDOESS-CEIi,FHR-r r ~ ~ • . r s+n o.. /-0 c•,. o~ •o•r ~ ~ l f..T r.. 1L c.tl.f1 T: :.~~-~_~-ln~lc''-1e .nr:.C11 r1~;jr~~ 1. L-f.c`iT~(1c~Zt~, ~1• rU111At. CREMAt10N. REMOvAt CEMETNr 011 COEMATOer-N.Mt tOC•t1pN o~ or ro•••- s••n - ~N'~remation jlRoyal Palm Crematory 'T1. P~r:~naro Re~c?i, Fla. ..o... D.. tf t NO+rE f'AMt ,r~~r°o ~n ""f''o~n~r 1•' 1" S:"I~4 i_e '~~t? t:-~c~ci F1 ~ebruary 7, l~t~ ~;y ~tlin~~on, of !tq y :1. v S. #612 tUN RAa 11EC10r SK.N~~uit A/_ p!G tlue-yG,r.turt _ • o.n aeearto a. ux•1 a[ersn,a Rev- 7/76 tit LC-~ l-: / f 7~. / ~ ' ' )N / ~ ! RKC:~yE~ I.i GfFICi:.t F.~CT~iiJ EUUK ~ . Gt.!r.:~E '.C,ii;:::Y, FiAktDA RECi!1t;;iU Iti 7Ni OF}j~.1.~11 RECORDS ~ &iir'ti W. `'iN:'.e (;f •8?G~/rAR~C.~'vY~•f!Oft7:7A rq ~ ~ ~ CLERK CF C;RCUt( c:)t)RT , • GRAHAM W. WAT? . ~ ~ RECORU vE2iFlED CERTI FI ED CO}'Y L~+~!r. % ,r~;;:,,~ I hereb~r,certify the shove to be a true and correct copy of the local Registrar's ~ ~ .record bri ~~i:~'e in tl7e Aroward Cow~ty }lealth Department at Fort Lauderdale, Florida. - -(War ng-,~ot?v&l~d unless raised seal of tl a 8ro rard Co my } al th Be t . i s affixed . _ r. , ~ ~ ` E' - County }}ealth O ficer and Local ReEistrar 1 • o~ ~j7;~- Chief puty Local Regi tray Q~+ G!2~ / ~ ' /5,~,~' ~~OOK ~ O PACE ~~Jr~U