HomeMy WebLinkAbout1537 ,i ' ~ .gel.
44'723 ~ ~ Y
IN THE CIRCUIT COURT OF THE TWELFTH
199 $EP 28 Pty 12; 29 .JUDICIAL CIRCUIT IN AND FOR MANATEE
COUNTY, STATE OF FLORIDA.
j'tIEO AND RECORpEO
jc~UCh1,f~COtn~TY.F~p. CASE N0. P 79-390; 52-264
~lERK CIRCU T
CQURT 9/~^'~
IN ~I§~~ta_. o£--.GEORGE I . KEGG, ) t
460'723 Deceased. ) -
STATE OF FLORIDA
DEPARTMENT OF Boti Graham. GoTEernot
Health & Rehabilitative Services
District tight Sarasota County Heahh Dept
P. 0. Box 2~i8 Sarasota, Florida 3~i78
CERTIFICATE OF DEATH
1~epNlwewbY~ ~~efWl ~ ReL.6lhl.lle See.lees fTATE ?ILE NO.
i11V1901V ~ Ilrnl-nl FLORID A
T1f/E. OR PRINT IN - elEC1iTRAR•a NO. -
?ERMANENT INK DECEASED-NAME rep ne.u usr SEII DATE OE OEATN l.owrw, Nr; rawer
SEE RA1gR00[ FOR .
wsTRRtTAIAS 1. ~ >L
RACE rrrr, weoq, u.teK•w wet•w, ACE-uu !weer 1 wen r DATE OE R1RIN IwOrI1w, o?r, COIRVIT OE OEATN
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CIIT, iOWN, OR IOCAiION OEATN waee ere l1rrS NOSEITAI q O1MEA EyST lr wN w emwe, ewre pep w rllnlseer
incr. ne a la -
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STATE OE RIRM 1 r wor M e.e.•., wart Of YMIIAT COIRLTRT MARRifO, NEVER MAtlAEO, _ SfOtISE 1 r w., on..aee.r +w.r l
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`"fer °K"are sOC1Al sECUUrr NIMYER USUAL OCCINATlON lone eaw p root eorle eeewa ror p RRW OE RI/SMESS Oe INDUSTRY
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••.wsslow• RESRIENCE-Sd/E COUNTY Crt1?, TOWN, OA IOCAl1QN w/see cw• awun STREET AND NIIMRE!
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IM. IN- le[. It/. W.
fAilrtl-ItAME r1eS1 nteele 1•p MOTHER-NtADEN NAME rrsr what a•sr
~ s John e a ~ t ill
l IIQORMAIQ-_ NAME MAING ADDRESS lflrp w • r.e. ra0., twe w w..., wr, erl
IuMa K 11~ 0~4 th t eet r de t n lorida
?ART 1. DEATN WAS CAUSED OT: (ENrEA OMIT ONE CAUSE i'p EsIE /0A N~. FL A/ b kA raw ~owsee w•tir
1, w.ew tnest
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cowsmows, n •.r,
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r.wa•re c•ele lel, ewe so, p N • cowrouewte p:
H•bwe rwf YNilS-
lrlw0 C•eH uet
MRf A. OTHER SRuIpI1CAIR CONDITIONS: cowelrorls torwseamrto to N•Iw e1R wel ruled b 4ele onrew w r•n / lel AUTOISt RTES vreee rlwe~waS ea.-
IRS OS w01 LNSle w Nffewrrwe tYleN
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_ pp~~1~ ACCIDE DA Irornw. or, n••l NOUA NpW INIUIr OCCUeeEO 1 e~• M?lr.e p wnn w ••n / a •u/ w, we. le l
~~.~I.r,DE~ OR IJW~TERew/EO
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INJURY wt WORe. ?111CE Of lI/URT •r wove, r•sr, prp, r•eroer, LOCAl10N 1 sntp a e.r.e. rro., am M rorw, M•r l
I S•epn AS q MOI ONIR Suo., ac. I eletrr 1
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CERTR=StATgN- rourw Ml leY •rorel M. sW w 1•Sr s•r rlwr/~ wart! ow / M/eerre •rlr wr NAM OCClreteO sne •l•tl, ow wr
?rfSKuN: TO rrOMM W re•S eON •/ree NAM. IwO11e1 MA, we, q ww rp
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u :eo Ma 1 ' 61 IIIJTUIe r4 ' 1 ~r June 4 T 1 lu. DID IM : OOAM_ ~ ~
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CERTRTIC/1T10N-MEDICAL ExAAI1IIER OR CORONER: Ow rwe s•sn p wle rrp:ie p N•wr rwe NceNrn .•s rwrrourKee N•e
!t•wwr•tgw p Irr SOO• .rile/Oe llte wr.efrrt3•rrerr, M .n prrwpr, nOMlw M. • My trees
N•1w O[LMMO OM M N1e YIe ee! re M 411ferS1 Sale!.
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CERT1fIER-NAME rrrn oe •ewrrr SIGMA r DA D r+wwr, o.*,1eM1
eeA111NG SS-CERfliIE Trap oe a r.e. rro. cm a lorr. pn er
r>r 122-. N-~ a~.m Ave. Sarasota Florida
Al TERT Ot C1tEMATORT-NAME LOCATION tan a re.w sure
lR~
•r
H.`.~_ ''-~~2~..'s~ r • N?Sar sots emorial Par arasota Florida
l r , 1;: tUIIERAI NOME-NAME AND ADDRESS 1 urp M es.e. wo., ern Oe qrw, sun er l
r _ ~~1 IT.Hawkins FEineral Home 1 N. Lime Ave. Sarasota, Fla.
v. S. A6~q Or1jCTOA- _ -SIGMA oAn Naneo o. low Nelsrw
Aev. 1970 ' • ~~i 1, . 1 IM Iw.
r
~n i:~ jt~~
A CERTIFIL~"CA T~~ ~ EMBOSSED SEAL OF THE-REGISTRAR OF ~VITAL'STATISTICS.
TRIS Y+-~ ? A DEATH RECORD ON FILE IN THE OFFICE OF THE LOCAL
REGISTR~t'QF AI.-;~ ICS, SARASOTA, FLORIDA.
DATE ~iY~~;.~ _ ~7 - ~~/1~~~ O~ -