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01-23054255
448511
T.1...- lTATt eowtto or NSALTII CERTIFICATE OF DEATH
e•¦•• • eURfJ1Y OI VITAL erAT[eTlq tTATt ?ILi lt0.-_
1.x.1 FLORIDA
erd s~•w 1 R 1 RA NO.
p r e p• r l7 1. ~t e/ et(ATN COOL ti0. . 11•IIAL Rlt{•IetN~C[ (R'Awt egret twt. IJ:..wwt...~ Rerle.•t• t4o• e•.wrr• 1
•i•t.t•R ~ OOUNn STATE OOUNTY
•.a .111 St. Lucie 66-025 F
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! ¦ p•r- R CtTr. TOfN.OR tACAT10N t. IS KAC[ Or OEATN t. QTY. TOM11, 011 LOCATION f. 13 RESIbENCE
.....t NISIOE c uYITSf Ft. Pierce INSIO[ nTr uY rn
r!1•. Ft. PieT+Ce rES NoO ~ r[sO No~
1, NAPE 0/ (/J¦et M t•r~lt•1, /ir thy( •Ihye) t. L[NGTN Or 1. STR[ET ADDRESS
ON A ?ARY/
~IRR)N Ft. Pierce l4etn. Hos , r M u
p 5 ~a. 2001 N. l~61h. St. r[so NoQI
I. RAtRt; N !S?tt N1MIt Lot 1. OAT[ J1bwM Dep Ye•r
. ( ~ 1?lotnas Jose HcN:anus DE"T" M 8 61
. S[x ~ OOIOR OR RACE 7. YARRI[D Q M[YER YARRI[D DATE Or TN ! AGE (lw pt•re t UIw l YtA¦ uNOtR tt HIS.
Jottirtt/•/1 Aferb tlew Mee•~. XM.
r t•• M W rna>,r[op avDRao N. 1 1886
¦ L t¦wp~r- la• f~ ~
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~ (t11N thf~ ~
t t)~ 1~. KINOOr WSINESS oR IIIOUSTIIr I I. RIRT1iPEAtI (Stdt M JWeyR ew.(r f) 1 tJtItOI Oi tJ01IrtRrr
¦•R..t Brick ~•ason Ret. buildin Ner1 York ti S k •
.1•Cti twit ( FATHER'S NAPE 11 YOTNERY MAIDEN NAME
er
e71••rlt•r Unobt Unobt
1 . rA3 OEtYASED EVER M Y. S. AIIYEO taORtEi1 K SOCUIL SECURITr NO. q. NI R NtiMATYet{
Irw.r.e.rl.ewl u~e..ew...~w..,?..aee? ALra r~c.•.anus
No 0 0-0 -116 ~u?ty Ft Pi a Fl
!••w• r •1 t0. tAt,IRtl K ettATN f Alper e¦J/ •we t••ae I~ Jfse /w (D), •Rt7 (t).) INTERVAL RET¦fEEN
d / r • t t•r rART L OEATY rA3 CAUS[O RYe ONSET ARO OEATM
...t rel. IYY[ouTE CAUSE Hy~grtenRive_ pneumonia__--
tYe e•r- -
t 1 t t e • t • , Cli.arl.w., t/ ap, ouE TD (N Se_eTEb2 Q_sascnlar_ accldent_
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1 e e • 1 ntwe taut (•b
r • E L • t r •r •t•tl'•~ n~¦ p(?E TO (r) _
• i R 111 T71 ~ ?ART R. Otltal SKIIItaIR CDlotrlOl6 OONIRIRItM TO pEATN RIR NOt R[IATE¦ lD THE f[RN•IRL Otf[ASE CgptIOR GRR>t M rARt 1(•) . wA A r
1•.r• •r- ~ p[RroRYEDr
t.r a••/. rES O NO
•r tf•r•r• ~ ~ ( ID6. oESCaRI[ Now uuuRr oeeuRRED (/illre? Rdrre ytRhrr h list t r P•rt ytre. »a
••tlwt awl ACCIO[NT SUICIDE MDYKRIE
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ew •r ~ ~ TIME Or //ytr L/iwt1. Dq. Yyr
• s d 7. REIlrttr a
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701. R/IURY OCCURRED 70r. pIACE Or NU'URr (t. b w •h••t A••Y. 70/. C1Tr. TOWN. OII IOiAT1pN COUNTr STATE
wN¦f AT ~ NOT wNR.E ~ Nral. ~•derf, dred,.~te OJIf., dt.)
rORK AT woRx
jl. l •tNndod tA• d••••••d /roar , to I`S •nd /ut u~ Ata •Jir• on ihai/ f{ e ~
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D••tA oexurr•d•t m on tb• d•t• •t•t•d •bor•; •nd to t/I• but of aIT Atwrbdp. ltom tA• uue•• et•t•d.
A11 it•w• ?Z.~~~
•r• to 1• (LA/?K •r thk) j71t ADDRESS 77t. PATE SIGNED
t••pl.t. b Alva D. Orr M.L. 616 N. 7th.St. Ft.Pierce Fla. -11-E1
Ae t•r•t•. Z]• RURIAL. t]IEwtp. Zlt DATE jar NAPE Or CEMETERY 011 CREMATORY 23/- LOCATION (CY/, hrw. M trRJ/) (gds)
~°Yr~a~"~1 5-12-61 Ft. Pierce Oemete Ft. Pierce (5t.Lucie Fla
T • S • /tSID j1_ fUNERAI E O¦ S SIGNATURE ADDRESS jS„0j,7E RECD. ¦Y IOCAI REG. j6. REGISTRAR-S SIGNATURE
xe..lsbR Milton W. Baird Ft. Pierce, Fla. ± 5- 2-61. Anna Lee venison d. r.
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'579 J':_"~ 19 F~' 3~ t, 3
~ ST.LUClECGUNTY.FLA.
ROGER POITRAS ~s`
CLERK CIRCUIT CO T < -
RECOrtD 1''"ZlFtF1._(~'=~fi°'0~--~ .r_
Hereby c.rtlty tt?is to be • true end aonc~f copy of the l+ocel t
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e Registrar s record tKl ftle in the $t. ludo County Heahh aPeA' ~ r
s ~ ~r ~ ~
meet at Fort Pierce, Florids. ~^Q~~~ ~
s (Warning: Not valid unless raised seal of the St. LucN ; ~<<~
County Health Department is affixed.) a~
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N. D. MIIIER, fiA. D. -
County Health Ctfficer b local Registrsl
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Df~ Deputy foal RtioianN?
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CI 31O C. 280V
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