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HomeMy WebLinkAbout2454 . • ~ 451802 ~ ~ vrrn~ s•ca•j~is~?•~~.:; . ti~ ~ ~ prc.Ir,TN~e~ n ?~o TVPE ON PRINT ~~EASib-•N4MI Sfll o~~e a a~~N ~ ruw~w, o~r, r~~~~i'~ ~N ~ J1NfCS 1lIOMt1.S GIDD13dS Male Jtu~c 23, 1978 PERMANENY ~~.___.~r.......~-- _ _ - BIACK INK uC~ ~wn. M~O~J. ~W~K~M ~Muw, AG(-•~?!~ ~•~_t~ ~ e~r CAtE d~MM ~~r, C01M11r 01 OEAIM ~ - - rc. ~ wcr. ~ a~n~.. ~.a~~i ..o~ y a.• rw.i •u~ i ' - --~i~.ite---_. __l~. 42 ~ Y_- . March 18 1936 Marti.n S~ O~ C1fr, TOM~N. 04 IOCATION~ pEAiM ~We~ un iwnf ipSMAt OR Ot1Uf NS~IIU11pN-N iM .n. ~N a~i, pa~ f~a~~ ~ne wwN~ ? ~iruN. qi o~ No ~e Yes ~A I~3rtin Manmrial Hos,pital ~ • - - - ' Si~TE W~uM ~w ro~ r. ~.~.a., r~r~ CIblEN OI WNAi COUN1tY MAttt[O. NEY[R MARRIE~. SV~VIVMIC? S~OIJS~ IM ~N~. ~n~ r~Ww w~r~ ~ u tow~n~ WiDOw(D. WvOR~[O1 Mtrn •~+~••K~ e (~.~1(~~(ya ~A ~o. I~1~L]~ea ____IiL~E7YjF1 Ht1t801'1 wM~IDKU4• ."'^'__r~~~7• ~~~10 M MaM SOCIµ K~'NIIY MW~E~ 11311A1 OCCINATION ~6.v~ ~M~ M~pR ~On~ NI~~MO rON M RIIiO OI WSM~SS OA UqUSlfl/ OC(Y~~/~ M rOMM6 lW, MM Y NMb ~ c~~y~ INS~I~Yf~OM.OA~ _ ~ ~.1i i'iY~AiWi ~•IAj~Wi~r~ ~7l.VLG ?~f~NrK~NWN RESIOENCE-SIA1[ C01N~fr d1Y, TOMM, Of ~OCAl10N Mly~ aN ~rnf S1~tE1 ANO MIJ/~~E~ ~ ~ . 1 WCM~ tH O~ MO ar' ~•a . ie kbrt Pieroe ,b. Yea 2703 S. 32nd Strcet. Iwtlrtt-nAMI ~~n~ awo~~ ~ aH MOtME~-AU~OfN HA~K ~wN •u~~ uf~ ~s ~ Gi.ddeitis Grif. • I~MO~MANt-NAMf . MAawG AoDtE53 Hn~a o~ ~.~.e. No, c~ a ro+.•, i~•a. rr~ n~. H, Gi~1g uo2703 S. 32nd St. F~. P1erC~ FlOY'ickz 33~150. I~~ ~ OEAiM WAS CAUSEO ~Y: EN1fI OWY Ot~ ~AUSE /Ef l~ 1W ar?~ourw i ( h~ M1L ~+D kN u~+u« o~se~ .r t~ wwer'i~~ru hi ' zs.a1~ ~ ~ ~OM~1~1OMf. N ~M~. rr~cw o~~f ns~ t0 1~1 • _1~~~ ~wrtMaq t~~f1 ro~, ~IM q. p N OONftprl~~, ' - ~4tIM0 ~MI VMN~ ~ ~iW~ CAYN 4~N ~ ~ ~ ~~If-~t~t?I~-F}.[/t ' N1tf r. OT1K~ SIGMMKANT CO~'~WT1ONSr COMIMM{ COMMMwO q N~M N1~ MOt Rup~ C~YM OnfN M ~Yt 11~1 AIROISY Y YFS ~rfH /~ws~Mp~ ~ 1 M~ O~ ~ vw~e~ rw Nl~twrM~i . I/,:/ ' W O~UM ' .~.~p~,~ f~_t:S1.P1~ ~ ~ i~-.C 19~. 19b. ~ OMK~Ol. O~ 1R~1lwwt0 A I.a.+~. Y~, ta~ ~ MOUR Npw IlW~t OCCY~tEO ~ INw~ wwY m auwr ~w 1•n ~ w ruf M, ww ~ 2M IOb IOC.. . M. 100. IN/UfY AT ~MOfR ?IA~E Of ~t wOrl. ~~W, ft~H1, ~K10~~. IOCAl1ON ~ NNtI O~ ~.t.~. MO.. ttA M/OwM. lf~p ~ ~ I~M(~n t~~ M MOI OM1p MM.,~R. IWCINI . ?M 701- ~9 ~ C[[fKKAiION- MOMt~1 M~ ~t/V rp~M N~ 1~Y ~MO l~tf Mr ~/MN MM ON ~~O(M rOt~t~1 My OlAIM OCCUN[O FN ?1~tl, o-,~ ?MIfK1AH: / (1' jO / rOwM MT RN ~ON~~nL~+~a~. ~••ow~ a M: i~' M~M z» Mi:?ee~ro~_.. ~ % ~ L2te. ~f ~ }r' ~ 2te. .2 7ts 2taQ~{Ef !M •o ~we e~ i CEt/HKATIOM--MEOKAI [7tAAWdER OR COtONER~ oM nN Nia W tw qpW q M~M ~M~ NCfpM~ ~y I~p~pYKl~ Nw I~~nwr~nOw M M ~(~Or uM/M IM Ynfitq~nOM. w rt MMWM. rOM1M M~ fla~ rOW p~~M p((yM~O pw M MM ~M~ NR ~O M C~Y11t~1 lt1N~ Ml 220 Ctf11f1El-IiAMf 1~?N O~ NWII ~_-__-Y_.•» SI~iNA~_WE 6~ ~m1 ~ ~bA~E SI(,N[D i.vwM :t, George A. ~irmail. M.D.-~,~ - i_ ~ , ax l • ~ i ?uIl1NG AOOItESS-CERfY~ER 2~~~ 'j~•Se o~•o / St{{$~L°"" Yf s~•r~ !2 339%A ,.RS F~ s~~. : E. ~sceola . ~ ~ ~'a~ ~ilf, ~p? {~i~lAl. CREMAtION. ~EMOVAt tE~r OR CltE+ru?iO~r-N~~wf IOCATIOH ar? o~ w~.~ s~~~~ D~~ua OPCVB ~~nuni f `°~*''S'"" ?y Buria]. :•o. ~ii„1].crestl~;~nari.al_la~ ~ __~or~_Pic~a:ce,_Flori~_ I 1 • OAIE ~rpnw, Mr, +IiJI WNERAI HOME-NAA1( /NO ~0(VfSf ~ UpU Ot ~.r o»O., t~tr O~ tOrn+, 11•It, b~ t ~ ~M Jt~ ~6_~___l~ ~s.. ~.ineral tiar~ Box 777 Ft. Pierce I'1 33950 ~ r iu+t caoR s~e+urua ~ ~s~ue Jc.,.,.^ ~ `~une '~~""'.~t.3'f~•• tse r J.t~~ir . ~a~ZI/ l ~ I hereby certify ~his to be a true and correci: • copy of the Local Registrar's record on file in the Marti~ County Heal~th DepaYtment in Stuart, .`,~ti; . . ~ ~ • ' ~ ~ Florida. -`'i''~: (Warning: Not valid unless raised seal of tihe f . :;i:. ~ • j-~" ~ . - : : N.artin County Health Department is affixed. ) . . . . ; ~ ~ ~ - ~ Archie~ McCailister, M.D. ~ . County Health Officer & Loca1 Registiar ' I ~ ~ . ~i.- • . . . . , . I ~,a"., e'~Z~/a De uL- Lqoa~Reqi~Lrar - ; . Da 1~ Y , ~ I _ . . . . - . . ~ . . . . , ~ . • . •e ~ ~ ' ~ , ~~i~Of~ ' , , • . ' • , ' ~ . .~~g ~J,r~ ~ 7 : i~ S 7 ST LU~(~ CC~~TY FE~ ROGEIi pp~TRAS CLERK CIR~~~j C~y„~, ' • • . Vi i'; ~ ~ Pr~t24~ B~~~x312 ; . , _ _ - k -