HomeMy WebLinkAbout2573 - 465153 ~
"'~''"r"E CERTIFICATE OF DEATH _
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En,rnEnq F L O R I D A Eoul ftu EEO. 369
TrsE DKEDENi-nMlEE fttlt fNDD?t t.ASt SEES WEE Cf p/..H,r>,:v,. !.l
Ot NI`.T
.E.:
~IEEEf Amo Nathenial _ Dou Las Male _ June 2 x,1979
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6602 ~ Black S.- 2 ' s< ' St1_ Lucie_ _ _
(ITr, TOWN Ot IOCI.t1pN p pEATN 1106f11.1 Ot OTMFt I+.S1EtU11pN-Nrr III w r r+.n. L+. r..w r.M.I ~ MOY G • St .,,ov OOA
Fort Pierce hawnwood Medical Center _ _Irpatient
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lAlMl tILO!•KE Florida U.S.A. ED. Widowe~ IE.
MMFtE DECEASED lIDCIAI S[Glnlr fIIMYE! USWII OCCTpAIEON /u• 1>.t .I.«. d•.• d.•w -
u.ED EE DfnTM nw w EusE•.Ess of ,rwsttr
:~`.~K:~ E]. ,b. Tailor ~Ien's Clothin~ Store
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Ems. rida T. St Lucie t«- Fort Pierce ,w 431 North 1 tr: St Yes
fAMt-NAME aESt .fEDDIE lASr TMEt.--r~.~aN w~rE E~tsT ~~DDEE
l3. John 'r>tebster Douglas Elizabeth (ur.'.-:no:.'=1)
,\fOEMAVT-IN1YE /]rN ~r,•./ EIIVG ADOtE33 S,tfET W ! f D E•O. cn+ W TyXV S'• )
t],. ~T Scott Johnson ,>w g06 South 7th St Fort Pierce Florida ~ j"
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tw. Burial tE.. Grove C m t tk. Fort Pierce~_1Qri~~_
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' E Stone Bros 317 N.7th St.Ft.Pierce Fla A 0
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l wTE S,WnFD nw. c•.. r..E f1OE/t Of pEA1M ' ~ ~ WEE SK~+ED IEr.. a•.. r..) Iwue of a.iti
E June_~1~?9 6:40 A. ,E ~ ]E. _ - - r
s« +.AAI[ Of AiiErOl!.v ?EIrS:C AN If OEEtEt iW.+> CttIIfIEE /f•N r,..••i- - - - j n ?grapl/-!C!D OFAO • Y.., 9.>. 1..I •?O•.a.'fED :f•J ' N-.
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t WYtf AND ADOIESS Of CFtiEf,Ef IMrSIC1AN. rEDKAI tllArUNEt1 /ffn ~ rwl ,
n C C Benton K N t?th Street Fort Pierce Florida
EE(:1S!tAt / WtF tECEEVfD Er eE 6!SiE•E ~w. D.,. 1.
~e ~QIQIEEO•VS /S~+r•n/, June 26 , 1979 - -
,f ANr ~i• UNMLp,ATE CAUSE FCVLR OS[I OSL .Q'![ I[t [H[ fOR /•1, /?E..IrO /•>J ~ v.o~ Oi° °•6w
wm O> W NE 1 ~
e s[ co 1
u/rEe~ArE rAn b1 "e8rs
Ul/sf bE E Hypertensive Arteriosclerotic kieart Disease ,
s~~ c T~ ~ ax To. a .s • cofaEOUE~+cE of: 1:.•..~ o.•..:..:-,.- r~ r..
UJSE UST -
~ tw Diabetes I~.ellitus -Double Amputee ; -
j EuEE To. of ws A caaEwENcF of 1 ~•...el E.-.... ~
w Abdominal Aneur~?sm _ 1 - -
!Yi OTMEE SKrtEfXA/:i CONDETEONS-~CwJ.~•+.cen**l.awp+d.o~.... ro. nb+•d+••.ws t, w.•... ?AtiEbl AUtOKr /SM.). i~rAS C.SF LEfff LFD'C »f~' ~
_ ~ Dehydration, Chronic Nep_ hritis n Y~o »A»~~E./~•«.,ti(rO,.., - -
Er,•t>nMrl ACCEOEM, SEM~OE
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. Hereby certEty ttws to t>. a true end oarrect copy o~F tf+e Loc.l 45153
Registrar's record on file in the St. Lucfe County Heahh DepeA-
rnent et Fort Pierce, Florida.
(Warning: Not valid unless raised seal of the St. Ludo ~ 1 `r' ~ - 7 • • ~ ~ 2 J
County Health Department is affixed.) - Ftl_EJ ~ti:: t'
ST.LI'CIE CL~iSTY,Ft;,.
ROGER POITF~A'.~
N. D. MILLER, M. D. ~GLERN C!i?C?'?T rrtl•~T '
County Health Officer 8E Loin Rpl!! .0 - 9~~ -
//J i Q, C~ . ~ ' It .
_ D~Y LOCI R,St7iSETAr