HomeMy WebLinkAbout1774 • t~t•.-~a CERTIFICATE OF DEATH
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DepElrtmenl of Health and Rehabilitative Services FLORIDA 4b466'7 EIr~TE s11.E~ iEO.
VITAL STATIS"TICS REGIE:TRAR S No
rvvE OP PRINT oE~ rleelf 1•+~ sE¦ oATt of oEArtf r ro«r N, e. •!•s,l
PERMANENT ' ~ ~ ~anlel `D'I. Sasso jrlale ,Au~ttst 15,19 /7
BLACK INK RAGE ~+rtr, ••IC•o. •wtrc.N rweuN, AGE -1•+r ugpr• 1 •fu li••o~t / o•• CATE OE RIRTM •.ro•.rr. s•., COUNTY OE pEATN
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CITY, IOWN, W IOCATrON OE DEATN wsref cln rrlrf ?IOSr11Al OR OTMEt NSTITUTrpft-NAME Iw NOr rN tlr.rrf. ant s•Nrr •rrp Nyrtet.
t> ~ Hallandale ~~'t`S~e'~°' 1~ 808 rr. E. 7th Street
' SATE OE {IRTH IN Not IN v s • . N•rt CITIZEN pE WHAT COUNiIY MARRrEp, NEVEt MwRRIEO. St1RVrvR~G S'EOUSE Ir .rr1. G~f r•efN wrf 1 ?
E:r' cOYNn•r WIpgWED WVOR~Eg Ifffcw.l Trs +
tl+Ot•Kf E Connecticut U_ S. A. _ sac`tY'r1t3Q „ L•~.ry _
...I.t otct•Ne SOC,AI SECURITY NUMBER USUAI fXCURwT10N rcra twe or wrOft t1pNf OWI•+f. rose or ItWD Ot WSwES1 OR INDl1StlY
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1, 04 -07-4284 ,y Dr2ck rlorrer P,=.^ sonny _
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~'•++s'o'+ tESIDENCE-SLATE COUNTY CITY, TOWN, OR LOCATION wsrof crn ,rrrs STREET ANO NUMBER _ _
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,.Florida ,.~3ro~~ard „Jitlllandale Yes ,t.729 N. 6til at.
fATMER-NAME ntsl rreeq a•P MOTHER-MAIDEN NAME rlafr dept us•
„ l:icholas Sasso ,t :dose t)ris
INEORMANI-ftAME MAR.R4G ADDRESS r+rqf• o. ! r o r•O. ar• a rorN, +r•n, er•/ . d1
Riary Sasso 'i29 i:.:~. 7th St. Hallandale, Florida
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BART 1 OEwIM WAS CAUSED RY ~EN,ER ONLY ONE CAUSE ?H lMlf tOR,o,. (6). ANO ,t/~ urrfaN orNr .w e.
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1ART A 01NER SIG?etE1CANT CONWT1pNS: col+pro.rs coNt¦yYrrw to a•tN wt Nor nwte ro c•wt cr.fN f•n . /el At/TdST ti rE5 r•ftf nraN
r•f NOI srefNS IN MtferlrlN~'~
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p•sbo 1 AC'CgEMT, SU tDE OR A Ri r rp+tr, Y•, •tu t aWlR MOW INnlRY OCCURRED 1 prltta wtvtf Or INwtt Iw ••p / Ot r•n n, ntr u 1
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~ INJURY AT WORR MACE OE NJURY n IrONf. •ur, ?rnfr, r•OO¦•, IOCARON . srfrtt o. ¦ 1 e No , un of tO.N, fr•n 1 ry.
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\ 1 •nf NOID rrrf TO • t1 O• r. t.grllecr
o L i - tr u ~ x/15/77 11/ /1- t n _ -1-f ,If D 17 Itkl ` ,x.0.45 ~M to tNf (.YSf,s, ,
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CERTIFICATION-MEDICwI E><AMwEt OR CORpr/ER Or rwe t•srs O• rllt rWw or a•t* rNt otclw+• +•s •tONgrr•teo ot•e
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CERTIFIER-NAME m,f oe .f.Nn SIGNATURE ofwN a rent GATE SIGJtEO IrOr•tr•. e.•
_ 5 l~ct~ ~IA5Coy6 5 - cl,~ :o~~ 9 „1 ~s tc,- "t-
MwywG ADDRESS-CNTUIER ~ srtf r of t • o r•O crn es ro•.. t•rf n•
~ `k'1 ~ctctNi~:u (~t-L= ~ f~ ~ ~~~c u'~'ro ~'1C~.1 3 ~~L~
t{//`Jy//]/\r. ® RURIAI- CREMATION, REMOVAL CEMETERY OR CREMATORY-NAME cOCw iION Cln w Krrti s••tt
,_w__ Cr_e__m_a_tion ,18oya1 Palm Crertator~_ ,.1 jromnano Eeach,rlorida
DATE r rN, O••. rf•tl FUNERA( NOME-NAME AND ADDRESS • +uUl of . r O No C,r• O• rQwr, A•n, 11?,
~ ~-f3/1" 77 _ _ ,~.~radlin on Greaver 201 '?'~.I3ch. ~3~.vd.Ii~ llandale, ~1? a.
~J 1 V.S. »672 UNEtwI DIiE OR- IGNAIU E _ REGI~TRAR--SIGNA?U E / ~ t J eat(;fCHvIO IOCaI ft ~ Si!•e ~ .
S/ Rev. 7/76 T ` ~ ~ Q~. t L , Ty 1 . 1, l - ~ ~ J•-t <r~Ll J ~ •IU
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CERTIFIED COPY ~ -
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I here~Ky=eertlfy the above to be a true and correct copy of the Local Registrar's'
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re~~'~ on file- 'f
p. the Broward County Health Department at Fort Lauderdale, Florida, y c 2
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(W~rning-Iiot valid; unless raised seal of the Broward County Flealth Dept. is affixed. r y
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- ~ = 46466'7 - ~ ~ -
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- ~ / ~~9 ~.~li -2 t"1" ~ ounty Health Offi rand Local Registrar
' ~''Mt - SLLUCtECO~-`~1Y.F11:
ROGER ?~OITn^A5 / / "
' ~ CLERK CIF.C~.f' .0'.T
Deputy Lo al Registrar - ~