HomeMy WebLinkAbout2994 - ~
- ~ ~ ~ -4.6.635
CERTIFICATE OF~DEATH
IN RE: Lot 4, Less the North 29 1/2 feet thereof of_KOBLEGARD'S
RESUBDIVISION of Lot 4 of RUSSELL'S SUBDIVISION in Section 28,
Township 34 South, Range 40 East according to the Plat thereof
as .recorded in Plat Book 1, page 37 of the Public Records of St.
Lucie County, Florida. -
. .~4 d Sssllh . ; OF D~~ State i'ue Ne_ - i " ~ -
at Vital Statistics F L O S I D A Re~'aza 1~ / aZ /
,i:rz~s yr ss: >R osvwl. olr nmcs~ -
(u onosv uPce.,ec~e ,
iw rr~*~ ~ w tliata ~ ~ . (b) ~ ~3 -
~ ~ - (e) cite ee ~
1'O"" x (a) strea:
YK~aot
metal a - - i
twspltal or fatdtprtloB. tarlq street awnber oe location) (e) Qti>DCea ot-trbreldn ~7?~U }
(N Lwtth of stay: >b baepitat et 7ros ee tto
!l} aLa of (~4, whether nwntha e: dais) ~ see. acme couat~ l
4
a stlti. t~ or n~cEwsm r~
S (e) ive oearaa. i (b) t3odat securlt, - t+aeat;c~ x
same ~ TLf~~.. x sat. at Deth: ns ~ t
~ -3~?iL~t,L.t , a a~ a Y ~
!1. I t~eby that I the '
t;. t3lq~le, mewled. widowed ae '
e ty >s mauled. widowed a a[ ( ) that I last aa~ h+id~elive • • sad
wife that death ooL~red m the ribs sad hour hated above. t>ntatlaw
e (if) .a/e a[ huebaad or wile. bt - _~u at~ ~ '
7. BIe1ti date of
- ( th) (day) (ye+r)
L wpt ?Mrs LLLonths Dale Tt tees than ooe dq Des to - -
/ -
- o ~ ~ ~ . . - Du.
~
o. o~ aonai
- or oolm ( a cocas ) (tnoluds nredOanq..lthm i months al!
t>lw1.l
~ ~ a>~s IIndetltae
the cease to
_ ((live date whiehdeath
oDeratioa) tIIonid b •
IL Watdea ~ ebu6cd star
tistically.
- ~ ~0 ,1t/
1i. Tt death vrala due to e=ternal catues#. >lII fn the following:
. Iasiaementle Sldna (a) (Probably) Aod~aT. sltletdar. homicide (specifyl
(a) (b) Date sot ~+M++*++~~ -
. HtalaL tics ae removal - (e) Where did ta1~? oec~ta!
(Citjr or taws) (Colmty) (State)
GI) Date - 3 - ~ 6 t~ (b) Plao in to ae atwnt twine. on farm. In ladustrial p)ace~
s
lhaeleral tllteCtae ~ (>~rJ type of Dlace)
(aJ While at wor Heap laltwy
AJ . s>I. Siena st. D
.Local ar (a) g 8
?s79 opt -8 ~ ~ ~ 4F1635 -
FILED ?NU Pt:CUnUEO
S ROGER
POITRA5~
CLERKCIRCUIi CdU T ~~f.''
RECORD YFF+%• r_9-i ~~~c.~~- ,~~~L
Irepy aM'trty this to be a true end correct copy of the Local ~ - ~ .
istrar's record on file in the St. lucle County Ffealth Depart- 1'r' ` -
I+~
~t at Fort Pierce. Florida. _ ,it'i}-;~ ~ •
ami Not valid unless raised seal of the St. Lucie -
~ County Heahh Department it; affixed.) ~ .
.
N. D. MILLER, M. D. ~';~-~.•~'r c '
County Health Officer 6 Local Reyistrel , ~ ~ (
Gi• r_.
~ ~ . - / j..
D~ Deputy local Reoiar,~r .
ll~
NI{ILI. ORI/FIN Jt:f*?Rlt{e ti LLOYD 9D~~~ • `~~rrVW
CHARTERED
P O BOX 1270- FORT PIERCE. FLORIDA 33450 -TELEPHONE (306) 464-6200