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HomeMy WebLinkAbout2484 • F ~ ~ . at-40~380 ~ ~ l 451~ ; ~ n~TS ~o~o o~ Mw.TM CERTIFICATE OF DEATH ' ; • ~u~~wu oR vn~ sr~mme~ F L O S I D!l ~rwT~ r~~~ No. ~ ~.i•i o~~ , RlGISTRAR'f NO. ~ P?~~~~1~ CODt NO.. Z YWAIw[NKMC[IIrM.~wa.r~/~w1 l/~~.nrw.w R~.~Mr?~v~~I~+rwi •a~erN~ 1. KAC~ N MA~M ti c~»Nrv . ~TM • STATk •~l •111 • ~ .`:L L'f_1G ~o ~lse~~ t ~ ~ i• R C/tr. TO~IN.OR WC~TION t. K K4CC W' DEATN c dT~. TONM.OI~ IOtATqN e. K R[S~LYMCE ~IfS10E Gi1 UYITS~ 'NS'OE CITY llYltsl •••••o , Ft Pie ~ res uoD ' erce ~ES _!aQ~ rii.. ' ~u?rc a t~/s~r a M~/+w. /ir.a«t.w~r) st~cct ~oo~css IIpdNT~l O~ wsnnrraM Pie ~t . u4 ~ 1 ~ -a~~ ~ NA~ N ~rM AfMM~ Lw ~ - ~ o~1c V.wr~ Uq Yea • ~ t~• ART!!UR `~TAi~LEY ~'ft` Ai~ o T" :.ove;::c.er i ti 1~b~. StX ~ 00~~ ~ Y~Illlt[0 ~ N[viR YARIIKC ~iE 0~ MQTN ! ~GE 1/~ Kv~ r u~Utw ~ rt,u yry(a t~ NK : !Mf At?N/q' M.u4 P~M Nwn lIN ! t~• j: y~! ~ rnoowco0 avoecEO A 2'il 1'': 1F84 ~ ~ 1~1~1 ~ 10~ uSU~I OttW~TqM IQi~e tW ~/w~! Mse l0A K~MOOi {U5~11E55011 tNOUSi~~ 11. 4~~N?~AC~ ! tiTNr w JNey~ ca~~n/1 ~ 1 prsteM Or ~w?i Goum~n j . t tr •r- ~u ..r N.wlIM n/ir. nr. y?~fbr11 ~ le~;.,an ketired Ka?~sas 1!~~' ~ ?l~tk 1~! ~A?NEIIS NAMf 1{ YOTNERS MAIOEN NAMI O~ ~ t~*..ris.. John D. R an Sarah :.teret.t 1. 11AS OEC[4SC0 EYER M U. 3. A~MEO PORCES) li SOCU1l SEW1117r Ip V IN/MMAMT ~~ONATYw[ i1C'i aj • ' 1., on ~~,~..«.,......y..,.,...., zb::-4.,-2013 wu.... ~,t;7 5. 11 ~.1;. : t.-~~ .'rr.ercc~ ~i. f~~f~l . i• CAYK KATN ~611e~ ~1~ Mt pwf lt? fiwr fv (~1. 1~1. ~w~ (tl.) INTERYAI ~M[tN ?~117 l OEITN ~AS CA116[O tY• OMSET ANO 0[~~N .~..~s.. ctironc~:o [1CtL40:118---- - _ - ~-`n~s------- ru. ~rrcou,s uusE w -----p--------- i er. e.~- ~ - E •it\e'tL~ YY.,Ippf. OtIE 1p n) ~ ~ ~ ~ ~ • 1 ~~Nw~ tM r~Mr• ~ ••~lstra~ ~ puc To (H ~ nsr_7 ~r - .~ss,. ~s ~ a.,s t.u. 1~Cttx' ntic..litsrt_Dfses~a----------------- ---t S-- 1AlIT u. o~~fA 9cMS~c~1rt OollanOMS aoMr~NlnY~a ro a11n~ wn wr 11cut[o ro n[ lcerrrt. a6usc oaanob GIY~w w?w~t 11~f Ms AuTOrsr • le~r• ~t- KRiO~~EDi a•~~~ Uremia- ~ephro-sclerosis - puLnohory e:r.t,fllism ,rcs~] ~00 ~ Nhr• ~ 7ps. oe5t~~~c Mow uuuer ottuRato (B~ta ~rr.~ N~*1~.~ iw Paf I~. Pr.t ll y t~~* it.) •~t1w~ a~~ I?CCroENT Su1C~0E MOM~C~CE ~~e~1- ? ? - ~ ?ie~. ~t ~I 70t. TI~Oi ~ wr ldwN. pf. Ys~r 3 ~ ~ ~ 101. w~r ooe~i~aeco mr. ru?t[ oi awRr (s. a. h~r.n..t Nwr. mj Cmr. tow~. a1 touTan oouwTr st?T[ ¦Nllt AT ~ roT Nm~ ~ las.hw?r.•n~er..~er e?4-. u~.) wWtll AT ~OwK t ~ 21- I~tand~d eM I~owrd /rom ~ 9bQ , fo __ii_= ~-O~ •nd /ut s~~ A~ di.~ on __.~-1~1: t;r' DwfA oowre+d ~t m on fM d~N ~t~Nd ~iw~: ~nd to tM Awt o! m) l~nor/~d/~. /rorn tA~ e~uw~ atst~d ~ 'r- ~ ~11 1~~~• jj~ f~MATY~ •(Or~r~r r tYlel IL AOOAESS ~I[. DATE S1fi1t6 ' •t• i ~ J.N. liatsche M..D. 6 Delaware Ave. 11-2~-c~ 4 •!l~f~L~. 23~ ~Ullul. dLWlT1pM. 2~ OATE 2]t IIAYE OF CEMETEIIII OR CIlEYATOIIY 23f. IOCATqM (Clf/. [Mr*. M ew~~tf: (St~lt) ~ 11EwOrAI (3ptn 1 ~ ia 1-? -5fi Nillcrest hem Cdns. Ft .~'icrce Florida ~.f.~Al~ 24 IUIERAL SS1G1M?Y11EA~1, rP~.Il• Jt..~ 2S OAiEREC0.~1flOGKl1E6. 2i.IlEGKTRAR'SSWM~TUR[ p••.~sss tdilton ir.'. Raird~vFt.Pierce Fla. 11-2£~-6c~ M~a i~ee uenison c.r. ~ ~ ~ ~ ~ ~ i€ - E ~ - - [ ' ~~Y QKiI}~/ ihli 1'O b~ / fftlf ~11d ODfT~ C~QY d~ 1hf IAC~~ Rpistror's record o~ fil~ in th~ St. LucN Counry H~atth O~p~A- ment at Fon P~erce. Fbrida. i~ ~ 9~Rv,, 17 1; j . ` ~ (Warn~ng: Not vai~d unlest ra~sed seal of the St. lucl~ " _ CouMy Heaith DepartmeM ia affixsd.) ~.`L~~ =,~t, ~~t~:~ . ST OGER i~U17RA~a . - I~, R ~nCUli f ~F~ - N. MIIIER, M. D. CtERR - Co~nty H alth Off~cer 6 Loul R~Is~f~9~ `'i:r , ~ ~ ~,s,,, oeou+,? ~«e~ Rec~,<..,~. g x. ~ ~ X ~ ~ . ~ ~ ~ P j ~ d ~ r i s ~ 6~:~)?•.~1~ PAGE~~ ~ ~ ~ ~ ~