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. Da- tTrwtr~ ~o~niio or NtALTrH CERTIFICA'>iE CAF DEATH -
..a a _ wilt9Ni o~ 1/1Ti1L sr~Tlsmca : '
'`l r•°• FLORIDA ra?tt n" T
t r?oa BI TN R[ti1SSTR •SI NO.
.porlp 1. KAC[ M ONATTi COD[ NO. t YtYAI RiS10S71Ci(BA..4rr.ttt..i UinlOdir.r itriaaNrtdLn.trri..)
waNd
.111 °0~Y Escambia ` "'A~ Florida O01"~"St Lucie
plaaoa
p. r- R tmr. TOBM. oR IOCATNNI e. K PLACE OF DEATN e. CRY. TORN. ON tt)GITNIN a RESIOErICE
Heel IIISIOE CITY LWRR NISIOE CITY UMRSt
Pensacola YES® No0 Ft. Pierce rES
t NAME aF ev(r• ~wpiht. pits.aaf.urw) a. STREET AooREts
N06tMTAL oR - _
'"s"T"'f10N « st Cerv ntes F sr Place
i NAOS< ot< /~frtl Yi/Qe Lqt t. OATS - dfiRti? Dq Y '
e[C~ASEe y? {
- Donald Jose h Stonbau - D~TN 2 6~C+
sEx t CauII Ott MACE 7. MAARtED ~ NEYEt MAIUIEO DATE OF wTM Atc (!R Ytwt w trMNx 1 KA¦ tRRKR tf Ieet
1 1 x..w n... x... xr..
• t t • Idale ~tihltC MnooBEO DlroRao -Dec. _
.self tot. YSUAL tXCIKATtOM~ (I(tgl4ayrwt ana N>s. IcNwoF tvsRtEss ote woIKTRY n. StRTNKAtE (sett w/Ms(Pa ew•op) - a1~t or BRAT ootarrRrt t
:b por- - avtN art yteerArw teEe. ttYa yrtttran ;
~•¦t Salesman allied AieWS illard, Ohio U. S. -Aa
.tit lpk it fATMER'S NAPE MOTHER'S MAIDEN NAME
or '
.~.rit.r ~r;W7.n L Stombau h Florence adages ' '
IS. BAs DECEASED EvER tI1 0.S. ARMED PDACESt K. SOCIAL sECURtTY M0. h. S SwS1MATYtit
lF.w.......lr.d fll.r.w....ranw.t.r.:r) ~ .
~o - wa+<.~ Ft. Pierce a. _
~.ral 11. LAYS[ tx OEATN (Atite? ta41 eot a•tt pw i(at/ir (Q, (S). tpa (d ItRTRYAL 3ETWEED '
•.a ce r rANT L OEATN BAS CAYSED ~Y. ~ CNKEY AND DEATH
•t Ella WMEOIATE DYKE p)
eor- -
'lent. ~~~(/tlI. D11E TO (p) i -
•D t?e ~te~~e .
• a - • 1 .iwe Bests (a). -
Dls-73 2
its • f- O MRT IL 071ER SIGA/ICAIf/ ODIR71tIDt6 CONINte{IIRI.10 DEATH Rift NtN RtLtrW ~ i1E 7f,Ni1rYL OEEAfE COIiiT?OM CIIp M rARI Ke) ~ - .BAS AYTOrSY -
- i - - _ ~ERi'ORMEO)
d.atD 1! - i
Defor. ~ ra?
eat awp ~ ~ SuICIOE IfOMICIDE DEStxtE N01M tNIYRY OCCORRE0. (Ells: zi'r~e'?/i'1h?I b pert 1 w PIMt IJ tyitss /q
.peel- ~ ? 0 ? -
of ~ -
I)/. ~ ~ TWE OF Hta/ lltaN, Dq, Yttr -
INNiRY an.
O el.
- i 20a. RUYRY OCCYRREO mR PLAC[ OF tMJYRY (s. I-. 6 M.ioet 4ent. mj: CRY. 707rN_ ON WCJITgN - ODYN7Y STASE 3
MNN.E AT t~ rgTIfNILE ? ~~./~r. drsd..~ot NaI.. dt.) -
MONK W AT BONK _ -
21 ~ bndd t dwaa•~d~lrof ~ . to - : ~ and /aa sa.r h~ arir. Din .
Death otoursed at ~'*~?/r/ifCtyl m .n tA. dab atatM abo?.; and to tM b.tt o/ w~ lnovNdh, lrom tM eauws .bc.d.
t lt.ae j~ fIGMATYt[ -
i fo D• '~y~~ (IkITa w tYk) ?2A. ADDRES.a ?It. TE SK
snlrat.. CltlJU?TIOR. ?3S. TE Z)s. NAME OF CEMETERY OR CREMATORY 23/. Tgtt (Cif/. ttsrs, w dsafp.) (STett)
aESOr.~ 3prciJfl
~~b 2. b6 Ft. fierce Ft. Pierce, Fla.
3. /A13 >;p. TYNE otRE oR 25. REtb. RY LDCAL REC. RECKTRAR'S S JtTE
..lore - A. fib ert, Pensaco a, Fla ~q~~
I hereby certify the above to be a true and correct copy of the Local Registrar's
record on file in the r'SC4~~IA COUNTY Health Department at
Pr
ESACOLS ,Florida. -
(Warning: Not valid unless raised seal of the ESC~~~3iA COUNTY - '
Health Depa'r'-#~Oient::is affixed.)
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4~ t ~ ~~,'rc~. COUNTY fiEtiL~i DEPART. r AND LOCAI. R~IS7~tAR
.±a.`t..yr~iL~l.~- .
ranch 1966 ~ DEP"iY-LOCAL REGISTRAR
Dame
ls79 5~P 24 PSI 2.3l 4~0?1~
FILED AMD pl:CUKt)EU -
S R
GER
POITRASn~
CL:RK CIRCUR COU T
RECDltD VER!FIEO~! QR c~
bilar 3~.7 PAGE