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sta~e ot1Florid~ CERTIFICATE OF DEATH ~
ORp/IrtTnent of Heat(t`aad RehRbititatirr Serlrixa trrwT= r+EC /EO. _ _ ;
• VITAL t3TATI8Tit~ F L R 113 X ~ }
• _ NCOIE+TIIARf•f NO 124
TYPE OR PRINT OEClASEO-~'~ .,H, "f'a't ~ SEi = DATE p OEATN , ¦o«.¦, Nr..tu 1
tN 1 Charles ~t : Mal@ , 22/ 1977 ,
PERMANENT
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6602 Cp _ , „ , 1896 ,a St. ,
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~ Ft. Pierce TI Yes N D.O.A. Ft. Pierce Mc~rlor-ial Hospital
STATE O/ RIRM . r «01 w e.t r1Art CIhtEN O/ WtYT COUNTIII MAIMED. NEYER IMAAr1ED. SIIRVIVNG SOUSE Ir rr1t, onrt Wetr IrIM 1 1
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- /A1ME!-NAME eHet rMMt Up MOTHER-AIAR7EN NAME .MP Nleelt uw ~
a. Charles Weischet a !
1l1pR1AIW1-NAME wuIDIG ADDRESS Iurer M a.1.e 110, cr. tM qvN, w.Rt, err f
T~.Mrs. Elizabeth F. Weisdiet IT• 1124 Pasco AV~E: Ft Pi 3450
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CERTI/1Gt10N-MEDKAI EttAMNEt OR COfONEf a. r¦ a.sn w Ny w«a w N.
2 n.e Ncea.r .u i..oNav.ce? ~r fA 1 l OPM ~o r c.r>ta1 trove i
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CEIMp;R-NAME .in M nova ~ SIG?tA1 _ r,Naa1 a rru OA S1[3NED I..o..w., N•, n..1
_Ahmad Rashid. M.D. • „ 2-25-??
MARNG If Patr W a «o arr A .
Ttl 1~`a~~`~~ 7th Street Fort Pierc ~Iorida 0 t
RUMAI. CIEMATgN, REMOVAL EMETEn OR CREMATORY-NOME IOCAiION - cm W q¦m s.•n
1 Vlar.. 11
Ttt _Greatiflal------`+W Ft._.Pierae._C~.~ato~ri rk oe-
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a__=__~'T~450___- .
- DATE , rp«r«. y...1•.. IUNE RAI MQME-NAME .Np ADOtrSS - 1 sngr O. a...e NO . cm p tOr«, suN. br 1 _
TM- F~r _ 1~~ ~ Yates Flllle>:'al Name Inc. P. O. BOX 777 Ft. -Pierce, Fla. 33450
VS. #612 ~u?+EilAl STIRr REGni~~ Arun OArt Natrfto e• ItXAI NGNIau
a.1,. ~n6 rn s-9~.c~ ;~~.c~u.a..c. <Gk• >w F 25, 1977
:
I Hereby certify this to be a true and Correct copy of the Local }
Rez~istrer's record on file in the St. Lucie County Health Depart-
ment at Fort Pierce. Florida. Lf
(Warning: Not valid unless raised seal cf the St. Lulls rv_,•-_•.
County Health Department is affixed.) - - <<"~"1 ~ t v~'
N. D. MILLER, M• D. z "
t, 1
County Health Officer b Lotel Reg~strar a"` ;
4sf?1'78 _ - ~
aM Deputy total Reoistr~tr
I~t9 SAP 24 PIS ~ 45 - '
FILED pllfl F~Clnl}~D
- ST.LUCIE C(~ttTY fLA. - t '
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