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CERTIFICATE OF DEATH •
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X02 s` k. ' • Mar.03 1902 T• St. Lucie_
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k '~-3121 South Indian River Dr. Fort Pierce Florid _ 0
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a~~,,,.-»/ ~ ~!u! F~rF 301 keechob Road
700 HAISLEY-HOBBS FUNERAL HOME Fort fierce
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CARDIORESPIRATORY ARRE
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CHROMIC ALCOHOLISM n
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ACCIDENT aw 10-5-79 r<._10:15 _pFr xd __LYING ON DINING R00[i 1 LOOR
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`s"<''" 121 S. Ind. River Dr. Pt. Pierce, : L
NO HOME
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stray's record On fits in the St. lutie County FieaFth Depett- ROGER Pt71TR~5
tat Fort Pierce. Florida. CtERK CtR~iJtt C4~"RT
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(Warning: Not valid unless raised seal of the St. Ludehi=C~~~ err"{ t
County Health Department is affixed.) ,
X6191'7
N. D. MiLIER, M. D.
County Health Ctfficer dt l Rpistrar
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