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HomeMy WebLinkAbout2074 r 45595 Et..a /,rt (.D. a ` acEOt?o-++~rt i(asE wootE uw su c+Te or eEAT((/r.. a.. i w rnltt n,: SYLVFSTF'R - EIISTER(~Oc7D Mate Ju•Cy 31,1979 fua( ((R ,Att--.. f.. wtu.. w«t. ADE-(..( WD/w vote 1 VEAL U/+DTf ( DAY DALE M tAaM /lr.. De. T.J C0111tIY M OtAtN Wye ' ~8 ..A .29 1901 Mctlit.Ln atr, Tot?Tl oe touTatl a DtAtN 106MTA? Dt oT1me asunnwla-.wr /u .r w .a«~. r•..«.~ ~.E.J 1~ ?rv~•. w Mi*. a i <-Y • j o?~rl n T 21t~~ _ . ~ S~uaht I?(a~i~,in M¢mar.La.C Hoapc~at p~ ~ . - sTAte or wRn1 nl... t. ar1w1 or T1nwT arw(ar MunED. NEYEt MA2ntD, s1a.v1vlNO sro11Et /o.Y•. f+• ~•~•....J . v=.i..... •++•sJ (~SA T1rloo~to~st..(/tJ , V'X+AI.ESIOt?Kt 1a Leavy Nd.X - v>•t1E OECEAftO . UvE~. If D[AtN fOdAl ffCUtlTY ?4111f[U US11111 OtC11iATIDN /CJ.• Ei./ N w! J.r Rl/o O~ MRINESS Oe MIDlA1tT - \ ~o~"~~E« t: 274-OS-3612 ,,,~•T.cJee°In~'pe~aTc'~Q','~"wred) Goodyeatc ADMIS.SIDtL ~~,a~-tltr v~ ~ - ,y. ~{.oiVKl(1 L J•l.. LKVW ~ • ~~•O! LOCATION IµtT AIO MMYEI P.ienee 2401 OLeanden Stvd. 1 S'ir' r ~ EAIMIL--(UM[ Rlfi M100Et UlT MEf-MAIDEN IMY! E(dT t?IOMt (~T i ~T~' 1S. James W. Eab~ta~uuood Annie fau@knen t 1!{tQR1RAN(-1LWt /Trn r I.wl vulw ADO[[SS suEET Oe e.E.o. N0. alv Of tOWN s1ATi _ Leavy . Eab#eruoood 2401 O.Ceand~. Blvd. F#. P.Lenee F.C. 33~ wN1Al, (1lMAf10N, ltYOVAE, OIME!/fMYlI a:NtiTRV Ot QtMATORT•-N•ME IOCAl1pN aTY OI IONM SiA1E H,i.~.ches~ Memania.C Gdne F~ P.Lence F•t. } •~`r'• rwtut~lT[ s:......J / f41lRAR 11ort BAIRD FUNERAL HOME 70e. . r.r A7 -#er txw.wa « 11r rrw•, a.d 21a Ow Oe Mw •t •.s+:.Mrw rd/« 1...s Iw ry ee~w~s+ d+aN ~ wc. W dw ~ M twMM Mr. ' / 1 ~ ' .avnN M M wr. M tai f(RS .wt !r f M te.~.hl st'.L ~ p....rr .d tw.l, -J c.i~~ G~~:r~ /~'4~~-•^ rz /sa.r.+.r ix+./~ 1 - DAft woww IR?•. /b. hJ 11o1R 0/ D[AAI ~ - ~ ~ S MTE f10NtD lM~. M. IrJ (U(R Oi DuM `1 rl• 7w? O - I • i ~ lDt. ~~7~I ~ Y s TR - f ` t1•Mt OE AT1Etoltq IITT,1aAM If OTt! TW1N WrVlt[i T~.~rl . ~ _ /tONOV+CtD DEAD (U•. 1i0. T.J ryOlq(11KtD DEAD (Rw1 i ,D, 211. ON 21•.AC NAMt ADDf(fi Of CT2TIHtt ' MEWCAI EXAMIMEq /Ttt•/r~f::wJ.l1~i~ / r f~ lEGOIfAt~ ~ pAtE NCF~ tD wr tEGISIfAt /M. On~ CO!OITIp4 2>•_ /sv.+w/ ~ r~ /7~,/j ~ _ ~ L-~?~-~- _ - . _ _ ~iLF ~ ~ ` / L wriKJ(~GAVt K 1MMEDIAT! CA116! )tMTp pML2 Of'[ !/flft ?t>! LIRE IDR I•l, I•l. AX frl•) ~ ) I.rr.•1 M~ rwr wd c-o~ sii~En w DuE p. OII A2 A C+D?6ED1rtAlCt O/. ' ) w«+.( Mr*a•. r:wl r.1 r CA{Rt 1Aft - ' 16 AM 23 DuE to. oe Ai A arsEalttxe IN...sl e~ --'e ~ ~ ~ o ~ ~c ~0 455195 ; -1------ - /ART Ot1tF2 SIDIDt CO141110?6-•djrirra crANry r rMA ~M w(MA r o~+r At(IOtSY /fN.iJt WAS C•Sf /Ei(::EC TO r! ['~'tAt a CLERK CIRCIMT C0t1~1T I t[•MU:Ef I `s•r jr le. ~ v.) _ Y' N.~Loly) ACC:D(M, RM10E • DATE d r+>,1er /Mw. D.s. Yr.l INNf'/ O(gliRFD. 1rDMIC.IDE. w 1?DEIERWMED /llwtlll tr.! ns. _ m M v1. - WJ(JiY At WOlR /S i.• MA[2 Ot IMMY-Ar Iwr. ,•.r...aKr, h: v.Y, •Prt• b..n•Isq, lOCA110M SirlEl M IT.D. ?M. ~Ulr Of 1.^.'AN • ~ ~ on iw•+317. rl• Mt. ISI_YIl J...__'v +n IC7t (N• Or'M 211_ 'zL . r-.~ ~sae(T I Y hereby certify this to bo a true and correcL• j ~ -copy of the Local Registrar's record on filo in ~ } the Martin County xealth Department in Stuart, i Florida. j ~ . ~ • "~~.'';1. (Warning: Not valid unless raised seal of the ~ Y~ .Martin County Health Department is affixed.) ~ ,y>~~ Arch McCallister M.D. ~ i t.. .7 ~ ~ • ' County Health Officer & Looah Registrar z,.s. ~ i ° ~ Ue1~uL• Lgaa Ragi tray , ~ _ 5?.~~~ Date ~ ~ : ~ ~ • ~ t ~ ~ • ~ ~ :3