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E AIfCO REC~tZE A. ~ ~
STATE OF
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DEPARTMENT OF REto
BOB GRAIiAY; Rt7VERNOR
Health & Rehabilitative Services
DISTRICT FOUR VOLUSIA COUNTY HEALTH DEPARTMENT
S O l South Clyde Morrie Blvd . OAYTOPIA BEACH, FLORIDA X2016
P.O. eOX 7~2Y
CERTIFICATE OF DEATH
11,Iw1r.rr1 d 14x116 •rA k.l.•Idlll.ll•t tirr.wN RiTAT[ BILE NO.
tN~IwMTN IN AI 111 FLORIDA
O/ ?e,?al IN ..••.•ww•«w,•+rna R[GILTIIAII'• NO I 1
f e.awNlNi INK OtCIAStp-NAMI •r•• r.aa[e uR Owlt W Olw1N • Tort+, •e•et
St( n~aD1001 IOR
asflutllo[S 1 1CHJIJT'!8 13)RRILL , 1•x1.6 , A 8(t 27 .1976
RACE ••rre, rI4e0, •wrK•r rwr, wGE-4a •wre , .e,: v.wea , w. CAII 01 RNtTN [rw,r, COUN1r d CIATN
;K~ t~l!`?'~re ,,•M•b2••.,•~,~.°• ~•t ,October 14 191 voiusia t
C1R, 1pwN, OR l A110N pl AIM rswe tr• Traa NOSrflAI OR O1MtR tVS111N110N-N Tr rot w rr.re, OM a,rn w rw•u t
Netrr •fe p re
Ch-?oond Beach Yes Orland Beach Osteopathic Hospital
S1Ai! d RaTM Tr rot a. v.a.•., r•.r CIIUEN d W/1A1 COtMTRr MAtR1EO, NEv[l MARRIEp, SINYIVteAG StO1rSE Tr .re, oM war ...re t
•F~., . 1•Sassachusetta `tee II. S. A. 1~~$i'rpTSnc.rt „ Z'Sar aret ~lentker
w~I.1 DI[t•r e!
.~.eo r a•r SCN:IAI SECtNIRr N11oeRER tISUAI OCCIIEAl10N te,M an•. or ,.oaa e+ort w.r. roa• a KRO OF WSK+ESS Ot INDtISTtr
DL[4•II• ll• - - r10e+r4 Tre,lVlr r a/Ma.1 D_
+„nv,gr, 6,•e 1~, ~L,, ~d 17Vat8
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•D-afor. - RESIDENCE-STATE COUNrY Cttr, TOwN, oR tOCATeON [r.« cw• Trws S REST Awn
w Florida IRl Volusia lr No Hill 1.. tYea « re
/.1160 Ri eltood A
fA1t+1Et-NAM,E ?Trae rage t•at MOIMER-MAIDIN NwAtE yr~wa_ y~rr~w! 1 [_•st
i, k w7fVR r•iil-~ OlUii
INIORMANT-NAME MARt+lG AOOtEft Winn a a.r~. ro., tr• a tear, a•a, ar.
1>` 2~s. S;argaret 13arri1l 1,~ 460 Ric3Eeuood Avenue• Ho Hi11 Florida
BART I. •??•p•r.• w ee•Y
D[ATN WAS CAttSEO 1Y: IENTft ONIY ONE CAUSE IEt tK+E IOR NL Al w?+O k1) een.ur o..an •w e+e•s
y, r.rww twree
N~ Chirrhosis of liver
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C•~:: p wl. (~ronia a~.~oholism
TrreN•te t•ral •M, .w to, a 4 • tA•ge0lrrCe p:
!t•t[r0 tit Br1a~ '
atw. C•rtle 41t
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?Al1 N. OTHER SNietITICAM CONDITIONS. COrMUOM(1 CpwMNrK t0 ex.Tr aN rOt Nur. ,tt C•rae GMr r•at [ •ar A~O/tr r YES r/a r,rMrRa tOtt-
Chronic obstructive pulmonary disease M .e. r• .nr.rrrwo c..el
~..~.~1r~ p .e•tr
/Ot, Ol N/OfftERM[M[~ r ~u t Now IN1Ntr otwtRED , t.[na wtrN or r.wra. r. cur . o! cur r, ww b r .
INJIltr Ai le?OR1[ RACE d N1URY •T nor, r•er, ataeer, r•ctoer, tOCATN7N r etarn,fi a.r... ro., t•Tr a to•,r, a.N t
C [ Naun ws a ••o a or,te wc., etc. [ NN7r• /
rw. f11 A
CENr~1CATN'>•i- rOrr M. •e•a nO•r.t erf te•t t•at Yr wr/we wtM Or t M/.Rit:f •,f•r nr OIATr OCCYaf[O •t tre n[,Ke, Or ire
•N~fK4M: ~ TO rprwt Mt leY aON •rna trwsr. fwoael Ntl, ••O, t0 Trl Na
r.::u
u ~ 12-?-68 ,w a-2?-?6 a-2?-?6 n. r>.1~ :3 o ~
CERTMIUITIOfi-MEDKJII EIAMMIEt OR CORONER: or >w a.sn a t•r row a w•r ire ueeeotrr ry reor•ar•ce. eeu
en..w•to. p ire aOw •ue+/p Yr r••eotrc.nor, M w o?roW, rWYt Mt RV rOrt
N•r Oe.CYaaeO b• M Mte •M e„w p ur uraew s••re+.
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CERTp1ER-NMK a•ee p rasrD g M.
Ore p Trle A E O Trprlr, M•, •eYl
1~:arvin R. Ledbetter D. 0. ~ Re ember 2.?6
MAIt,iG AOWEfS-CTRTRTER aae• u... cm a att,rr s an
>n+ - 2129 North A~.aa~t~;c Avenue ona Beach `l~lorida ~ ~
CREMAigN, REMOVAIf ERi at CREMATORY-NAM[ tOGT10N Cr• p to•rr sate #
CSreIDatiaai T.?Cal'dF11e1~3~Ee LeWi,s (~etnafio Fb~"t Or Florida
_ , A E 1:- 1 r 1~?b n.a• weEtAt MpM~ WAME ~ND ADDRESS , ann a a.r.e+..o., cn• a to.nr, a•n, ew t
9 6 ,,.Dale lI dxard F. H. 16 Ri od Av+ernte • Ho Hi11 Florida
w• .612 ~ itME ~ REGIS - wt owtt cs yea n otwl eeeTSteu
• rf• ~
K'E HER •
I
~~~RT~~' ~ ABOVE TO BE A TRUE AND CORRECT COPY OF THE CERTIFICATE
ON FILR?.•~'~T•~g'~'. ~ A~ ;jtE6ISTRAR' S OFFICE.
~~~;'~~U~r~~`$EAL OF THE VOLUSIA COU
~,n.;.;~ NTY HE LTH DEPA ENT IS FFIXED. )
' •
1979
' , ~P~: .
A ;kyy=~. LO L COUNTY RE TRAR ,
L DATR`.~~'f~,• J
CHIEF DEPUTY REGISTRAR
BonK~71~ PaGEi~
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