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HomeMy WebLinkAbout1650 i~ ~ 9~9~53~ ~ r~i. . sTwn ao~o oR NsnLtw CERTIFICATE OF DEATH se~~~ • ~1711~/1Y OI YITAL /TATIfTIq RAT~ Fllt NO. ~~sa~ ~~s• FbOBIDA •r~ ~A~~ R 1 A • NO. ~r~0~e1y 1. KAfs N~f11 GOD[ NO. 11 ~AL~ N~sNt[l~w..wr«da II~.uMvt~.w~. s.d..~.+.~.w.w) ~:~t~t~• a COYMTII aw~ ~~I1 ~ ~l~e~~ ~ 6 t. cm. io~. oR ~ocn~a~ c. K rua a as~ t. CITY. TOMf11.011 LOCAT~ON t. K REStO[MCE •~e~~t aKWt C~T1? uM~1St n~a~OE C~1r urRf~ t11f.• ~[S MO? ~@ 11ESQ IID[~ _ 1. MAYf OI n„(~~PTal [1,~~ratNb~N) s 1E11GTN Of f. STREET ADORESS raMUtwN e~er-oa~P~ ospital 3fi"~frs~: ~ res0 N ro 7~ I1r~! A/YI~ Lyt E XwN Dq Ynr ~ c~"' ~ ' J A RF:I D °~"T" Au . 6 t 96 ~ StX . OOlOA OA IU1CE 7. MAll11E0 NEY[11 MAIlRIEO • OATE Oi ~111TN AGE U~ I~O/ i 1JMOtl1 t rtY Yh0[~ i~ MK. ' tYf ~sfNq) NwN~ Ww Nwr~ M~ e 1 t• 1~1001N[C qY0RCE0 ~Ct. 2 ~ 62 ~l ~lnl~ 10~ USY~I OCqDAT1011 (Oiq th1~Js~r! ~w~ 1~. K~NOOF WSINESS0111M01lSTI1T 11 ~MTN~L~CE (~1~ft ~ fMty~ ew~~fr~l 1 GT~iEw 0~ ~W1t OOiM~rt s i t~~. r- ts?~~I ~wM y w?!iy dk. ar~ 1/ ~d1?eA ~ Eethel h.C. U.: ~ . ~l~tt l1k 1 IAl11EA'i N~ME ~ 1. MOTNCR'S MAIOEN NArE .~r ~ an..~s:.. e Rillie ieal ~ ~ MAS O[CEASLD A 111 Y_ i A~MED f011LZS1• K SOCIAI SECURITr NQ 17 IN/MrA • NOMIITYR[ ~~Qr ,e H. ~ieid ~ t1~. M. ~ drwl tt/ M~. w~+ wr • i~w d~wwrl E~ ' avail2bie i1 fio. it;tn. :~t. tt.Yierce 3~-ia. ~...r.l Il ei?wt N~s~?TN (Aker wi~ Me eawr /rr tt~e /w c~. te). s~ (a1.~ urtcarnt ~wEi~ l/ t~~ t~t ?ART L OEATN ~AS CAIlS[D ~Y: d15E? A11D OfAtN ...e rsi. ~rrco~?a w~sc w Pneur.~on,Za k L. lower~ot;es _ G days ea. e.r- ~ ~1~1l1t~ ~ ~Jpt. . .~c. er. ouE *c ce~ C~r_ g~omeru]_~ne~hritis _ _ev_er Yrs ~ . ~ . ~ .e.. ~,w.yf•~ • ~ r~~i~tr~r ~ w~I Ae a~fn- ouc m(d ' ~F~r •!t?1• 7~ \~~r• •f- ~A11T N Ooa SKr~u~rt Caar~oMS GoKrMlrrw w Oc~Tw ~ur Not ~r[o ro ~M[ furwk D~stas[ Caano~ Wres w rwiT MAS AUTO/Sr ~ ~ tEIIiORMEDI t~r ~~ttM 11E5? MO? - ~~t~?• ¦~t~a~ a~~ AOqo[NT SuK~O[ MoMIdOE ~ oESp1a[ ~ww xuWlY OtCWIREO (~+a ~~tti~~ yaJw~ h Prrt 1 w Pat l! y i?rw ~t.) ~i~t~s!- ? ? ? ~a e[ TutE oF flwr alwM, D~n. Ys~ - .ea~. InJUltr a r. f~. - - ~ m/. MtltlRr OCCY~iIED 7Dt. KACE OF IMJUR~ (t. 61 M dMYt Mnt. mI CIT~. TOMM. OR LOCATION OOUI(T~ STATE ' w111Lt AT ~ IIDT ~IRF ~ Jp~. /~I. ~?M. Mts N~I•. Wt-) . ~ORK • AT MORK =1- !~tNndrd fM d~owwd /wen ~ 9~+6 . fo •nd Lit a~w ~li?~ on ~ DwfJ1 ooe.wrnd ~t • ~ on tM d~r~ ~t~bd ~bw~; ~nd to tM bNt o! a~ Rnorhdh, /rom tM uu~ ~t~bd. ' ?11 it~~s~ ~ •r• t• 1~ (Grf?a ~r tYk) 27d ADO1lE55 22t. DATE S~CNEO "•~i•~• od~rin Jr M.D. Ft. Pierce Fla. s 8 63 ~te~~at~. ~ ~4 ~i~ ~ jk ~MEO~UMETER~ORCREM~TOR~ t3/ WGTqN(GY1.lan.M[w~~t/) (g~) ? 11[YOrAI (SPtt~//l . 1 6 Ft Pierce Ce:nete Fort Pierce Florida ~ Y. S. f 01= j~ iU1'1FIUl E OII S SI6lU1 ~ate~`D4'~?era1 Home ~~0. ~y LOCAL REC I6 RECISTRAII S SK!IATURE i ~ ~••.~aas W ates Ft. °ierce Fla. 8-12-63 Anna SJee Denison, d.r. f ~ E ! i € ~ `~19 28 f?: ~ ~ 2 . ~ f:~EL'FYU""(;r:fLA. - - s-:' ~ ST.LUCi~ ~GJ`tTY. ; ` + ~ , RCGER F•OtTRA~ , . ~ ~ ~ . ' , n~nby aArty this to b~ e trw and aorr~ct oopr a~ fh~ lroc~~ C:ERK CIRCUIT CQ~?RT t'~• ~ ~ ~ ~ ' ~ ~ ' ~ : . . R pishar's reoord on ffl~ in th~ St. lucl~ County H~+hh D ~ p~~ ~~~j - S C 03 a ~ ~ r(Zr'-" 1: 9t~~= ~ RIN1t at FOrt PiertA. FIO?ids. ' , R . ~ (Warnin~: Not valid unless raised sesl of ths St. lutl~ 1 _ ~ Gounty Heafth ~epa~tment ia affixsd.) L~L~~31 ` n` • . ~ G: . ` ~r ` ~ ~ - ~ N. D. MIItER, M. D. ' ^ ~ ~ =?'l ~ i• _ . ~ Gounty N Ith Off~cer 6 iod Rpist~a~ ~ . ~ - ~ _ ~ - ~i~ . ~ p~~ ~ Deputy Loc~l Reaia?,~r ~ 7 ~ ~ ~ ; ~ ~ ~ { ~ ~ ~ ~ ~ r ~ I s~K 311 ~f 1~49 R