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ip: fit. CIlt.1'OON.OR LACATI011 t. b KALE p OEATN t. CITT. TORM.Ott LACATgII t. 1! ~Ef10E11C[
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; " TES ao Fort Pieaece res ~ ~ p
L1AYE Ot (~A11 ~ fM~ar. /fit tl?1rt aM/M1) 1[NaTM oI sTIKET AOOaESS 011 A ?AaNr '
t0~" Ft Pierce lit. Hos sTA~ ~ 1016 Sunrise Blvd. Ks0 ao®
. MAC N llnf bYrt lsll t. OATS lfMlr ON 1'
- (.ash"'..`; iq H°>~t'd L. Bu~'PO uTM June ?1? 19~
!E)1 COLAs OA RACE - YARRRO ~ uEVCa YARalEO -OATS OI OIaTN Aa[ It's t>w At..ll. O.w R.w Atl..
s s a Male iihite RloalrEO avoacEO Oct. 1888
~~7 " IM. 1gIMK oCC(IrATloll c( tW y..r! 100- Kab 0I WsIr1ESS oa iN011ST11T 11. ONITIMLACE (91h1r w JMtira asst?/) CIr0O1 Ot .IMT A01/IrR+r?
rit! ~a?- .pt wrllye+lt.wnynw.n USA
..r..a eer C & 0 RR l~lartinsville, Ind.
r>tia! as IATiRaY MAllt - 1 IWTIIER't M/UOtll aArt
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ln..tasat Elizabeth Stotts
RAs scaASCO EvEa L! u- f. AA11[o . lotlAl sEtuluTT Iw. n. s saru?TwIE Hafard L Burpo, Jr.
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.a»~ ACCIOEIIT SIIICIOE MONI[IOE OESCIIIOE NON NUU11Y OCCVIIRED. (~lllp fa2srs ylyw/ Is Pwt 1 w Awl II yknl IEJ
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at. J attaw/rd?Ar dbea..ad fmas 1962 . to June 1 and wt... A
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•sl•N ~ Alfred J. Cornille, H.D. 403 Hibiscus Road /2663 ~
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C ORTt ?3t. NI1ME OF CEMETEa.OII CREMATOIIT ?3/. LACATgII (GTfI. gvfl..r pa~It/) (B.Ot)
Ft. Pierce Cemetery Ft. Pierce Florida
r . s • Ian ~ ~ 901 I~h St • 2S. DATE IIECO. w LACAL RE•. REGKTIWl3 SKaA
~•••a~as_ _ Milton W. Baird _ - 1 6 - ~ V fa N. Borland - s.r. -
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ispigtil~s neoord on fIN to the 9t. ludo County HNhl?-Gw~;~ . -r; - tx~ItcalCUitco
Tent at Fort Piers. Florida. - - i s' ? ~ ~ 1~~
QNamirq: Not valid unlasa reined seal of tF1e St. L~€ ; ~ ' = ;;~t:
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Cou1Mr Heelth I)epertment is affixed.) ~ ' ~ ~
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