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CERTIFICATE OF DEATH
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IK\ICNI.\IM IM\1111 FLORIDA
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R(GItTRAR'S tv0
atiNANENT INK DECEASED-NAM( •nf• ryo.l ~SEY OAit Oi DEATfr •.o•Ir., o•., r(••.
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'"""E1i0's ~ BARTHOLOMEW COLLETT iMale Se tember 4 1976
RACE awlrl, wt4.O, •W •K •r :wh•rl, AGE-l•,r V••Dr• 1 rlr• Y~LII 1 D.r CAiE Of RIRTM ~ ~wl.•., o.r, COUNTY Oi pEATN
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/ _ White 75 s, ~ .Jan.23,1901 Martin
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• n Stuart ,r es „ '•:artin '•:emarial Hospital
~ STATE Oi RIRIM r r rOr w Il.i r•>t CITIEEH Oi Wt1Af COUNTRY MARRIED. NErEt MARRIED, GSUtviVNG Si'OVSf_r r .nl. 6M r•.plw rurt 1
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• .•1.1+~..~t , Pennsylvania , USA arriec~ Ethel Brader
r O(•« SOCIAE SECU4TI NUAy(R uSUAE OCCU?ATKkI lari a«. a Olt DOlri OIIII.10 .oN a ,KWO Oi WSwESS OR,NDUSiIr
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~~+',I~r~r.•o^l ,~84-32-2135 „ Court Reporter Court
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"f¦'o"' RESIDENCE-STATE COUNTY CITY, TOWN. OR IOCATK)!l Iwt»l cln wrn STREEt ANO NLLMRER
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((Florida ,•$t. Lucie Hutchinson Island.,,, 9700 AlA
fAillEf-NAME Ntlr n100(t r•it MO,MER-A(AIDEN NAME rrir .10•al (•ir
George Collett Charlotte Stacey
iwORAiANT-NAME MwtwG ADDRESS Ifrulr a rrp • ter b q'rr•• irAw• lrl Fla .
Ethel Collett „9700 ALA Hutchinson Island, Jensen Beach
?ART 1. OEw1N WAS CAUSED RT.
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CERTIi,E^R7-''NAME m/N~/wJ r¦«n /j~~ 1 SK,NATURE _ - /~'~!l u r l OA S O ~~w+w. o. rlul
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MA,IwG ADDRESS-CEHrtrtR f•n(• w • r e rro / m a rw.. sr n n.
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RURUI, CREMATgN, REMOTAI CbMETERT CN CREMAT T-NAME ~.+OCATION un a wr..r u•N
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I; ,l. Burial ~,li All Saints Cemetery Jensen Beach, Florida -
GATE IrrQMd, wr, nun .iUNERAI HOME-NA/vE AND A.7DRESS ~ urur o• • r c ..o . or• o• ro..., ir•rr, ur 1
,.i t.8, 9 6 ohns Funeral Home 961 C lorado Ave. Stuart,Fla.33494
5. .5 12 ~ wt plt-Sr r - RE S AR-SIGr(•ruiE o•n cl~re i. (OCA nelsr. ¦ h
~ R. v.197J T r+• IM `7
I herehy certif,~ t'~is to be a true and correct
~ copy of the Local ^.e~istrer's record on file in
the ''artin County uFalth ~epartrlent in Stuart,
1 Flori~+a. v
f!'arr.inp: 'rot valid unless raised seal of the '
~ ~ ~ "artin Cnunt~~ health ^rrartment is affixed.;
l- Prchie "cCallister, !'•r.
County E?eal th CI`f i cer P Local Registrar
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