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C :TIFICATE OF DEATH
Oeot..tert a( tk.lll ..d Rcletwliteli.e $er.Eara tTATt E?iL= NO. 4
~ E~a1.T11 FLORID A
TY?E, O! Rl1Nl IN ataetr ar w~a•.t•r•aa S _
RiGIRRAR•R NO.
!flMi NEMT INIO OECEASEO-NAPS[ SE; DAiE Of OEAM
~t~E ~ .Wt rM1 t•fl trertr, Nt, •IUr
~r~T~ ? Pauline P. Goldston TFemale ,October 14 1974
fACf .wow, ¦ww. •rESrc.r clear, AGE-uu Y..an r •E•. ~ u•rta ~ o•• OATS OE !I!M t.o.rr, e••, COYNTT Of OEA1N ~
/rc. ~ arEC+. ~ ware.. t •c•as t .oa, stn wows nu t
6602 White 79 ~ w EJune 9 1895 la Saint Lucie
TOWN, O! l OE AM wsW trr twos NGSMAt Ol O1Np lESTIMION-NAM[ rr tter w awsa. ~.:~::N, -...~:c :
srscwr •IS W r0
~ Fort Pierce ?t Yes T. Fort Pierce Memorial Hos ital
~ fTAtE d M!M t r rot w e.a .r.ra CETIZHi Or WHAT COIM+1lY MA!lIEO, NEVER MARMEO, s11RVIVliG SI'OllSE t r .wa, ot•a t••Nr rAw I
coww•? WIOOWEG. DIVOlCEO rsrKnt
rseuwsra.rc. E Tennessee ~ U.S.A. 1, Married II. Ernest G. Goldston
tt~rre~ ~il
w SOCIAI SECUUTY MMYE! uSUAI OCCIXATION rarn aw a •raaa rorE erarto row or III00 W lI/SHEil O! MOOISTlY
oectxw w retarto trc, new r uwaM t
'""'""'0w•°"' IT. IL Housewife Ii• Domestic
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•~ttssbtr• 0lSIOENCE-STATE COIMETY CITY. TOWN, Ol IOCAT1pN eats cr? trrs STlEET ANO
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Ip Florida Iw St. Lucie Isr Fort Pierce L. Yes Ia 3061 South 10th. St.
fAilsTl-NONE twat rweY ust MOTNE!-MAE4EN NAME near rtsatE tu+
Is Unobtainable L Unobtainable
I WOlM/WT-NAME w?RwG AOGlESS tstaeo a a.ri. rtp., ut• p tor, u•w, Ee,t
IIa 1713061 So. 10th. St.Fort Pierce F1a.334S0
I/yT I. OEATN WAS CALSEO !Y: (ENTE! ONEY ONE CwuSE IE! t!t r0! h). M1L ATID kA ss•reEw o.rsn •.r
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CElTYKATION-AtEO1CA1 EIIAMYiER O! COlONEe: a. r.t s•sn a twt w[H .a eactawr .u •sowar+Keo w
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N•wr occwer ow w o•a ..te rtw to •.te uvu.u s+.ns.
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CElTIr4 t-NAME ~t•N W Iu..n ; SIGMA ~ J, ~ DA SI(tNEO ~•~e~•*•. e.•.•wI
TT. Melvin Wolkowsk M.D. Iw '(7,LJ/l/ T,r10 16 4
HARING ADOlEST-cEfrir! Brut. a a...r un a •o•r.. sr.w tr
IT• 80 North 7th t ort
illRtwl. ClfMAT10N, sO;MOYAI fASETElY O! CsEMATO;Y-N.WE IOCAIIpN an q torn f••N
t f?!CM• t
rt. Removal r? cab- rchard T« Oakdale Mor an Co. Tennessee
GATE r ro.nw, w•, •w t ftiNEULL NOME-NAME wN0 ADDRESS ~ sour o\ s r.s. wo.. em a to..t, su*e, t.? t
T4 ober I6 1974 TI. Fort Pierce Funeral Home 106 So.4th.St. Ft.Pierce Fla.
Y. S.l612 T1IaE o~c?O!-SIGMA lEGIS, -SIGNwrulE r ~ oAw acEt.EO s. ?oW actsiw
l.I,? 1970 ,w (~c~ ~cclC I • • f~ ~ l,.n` , ~ . ` N? nctober 17 1374
t h.rby certify mt:i ro be a trw end corr.c, Dopy of tn. j9 C`• I I ~ Pi ~ 3" v
RopistreT's retard on fire in the St, Lucie County Haetth t~ert=~
merit et Fort Pierce, Florida. F,i; L' =s.!'
(Warning: Not valid unless raisE:ai seal of the St. luci~ ST.LUC!E G~3( ~ •;la,;,t~_;.
County Health Department is affixed.) RQGEri PO)TR
CLERK CI'r.~l;l! L: _j. i~ r' -7 ~r .
N. D. MIIIER, Ml D. ~ ~ - -
~w Hwith Offiur b toter it.gistrar 4~i2609 : = _ - .
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p~~ DoQury local Reoistrsr ? ,
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