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- eaa of irlotida CERTIFICATE OF DEATH t
Ocgrtment of Hedlb oed RebablMathe 8crtkw F L O $ I D !l - **wTw rf~s ao.
VITAL e'PATMTICd wcais~www~s ••0 675
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w Ft. Pierce ti es Nir't. Pierce Meworial Hospital D~Q1A. _
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,/tFlorida St. Lucie Port St. Lucie ,a no a r N. 864 Terra Court
A ~ h•f1 rNtl Uft MOTtl~>M~1ptN NAYf trlt r.wrt uf•
,t Lsttrence Lynn --Mattocks w Bertha D. Koonce
w?aevo Aooetss tlwft a • t.e. tto , c+t a to.r, ft.w,lrt
Thoaae J• Apan _ 864 Terra Court Port St. Lucie Fla. 4 _
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N•r tK1tMtN ar N MN •tre eM t0 try eanfat 1r•tte e~ _ ~e
_ ! C. 197_7 1i~23 P.11
- « M HfGNt Ot rtf bZ~~t~K~ rrhrrwr_..•, •tNr
L Hooshan Kadivar M.D. ne _ _ n, 2 - • 77_
~ifNO aoo -c c 0 N th Street Suite Ft m erce u•~ 4r
•fOtr -NA•t( l AIgH trn a to.n• fr.q
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w Burial ~ Hillerest Meworial Carden ~ Ft. Pierce, St. Lucie Co~. Florida
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NOMt-NAAtt grip
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o:.... ro., cm o, to..., f~•N. w. POrt- St Lucle
w Dec. 1 1 7 n•Ao r L
VA. ~a1I -tl~--- eEGtS fl/•t- e• nclr.t° toc•f nmfr
p'e• tote w. rw De ember 12 1977
Hereby artily fhb 1"o be a true and Darrell Dopy of the Loce~ 460212
Registrar's record on file in the St. luc~County fleahh DepaA-
rr,ent at Fort Pierce, Florida. 1919 SEP 25 AN 9= 43 -
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1 QlVarning: Not valid unless railed seal of the St, lute - ~ ' - ,
Counly Hsahh Department is affixed.) FILEO ANO kECOkDc0 ;r; ~ `
ST.UfCIE COUt1TY.flA. ~~Z~ + ~
ROGER POITRAS 'c
N. D. MiIIER, M. D. CLERK CIRCtftT COU T ~ _ • ' ' '
County Health Officer t 1AC01 Re~aRO vfalFS;a~ _ • ~ _
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Dare DrptAy I,OCeI Repilt?sr ~ . ~ , i= ! ~ 1'
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