HomeMy WebLinkAbout0062 46'7328
RE: Lots 22-H, 23-H, 24 and 25-H, Section I, in that certain
condominium known as OUTDOOR RESORTS OF AMERICA AT NETTLES
ISLAND, as shown by the plat recorded in the Office of
the Clerk of the Circuit Court in and for St. Lucie County,
Florida, in Plat Book 16, page 1:1A through 1J
46328 :AEBY CER ~ ~ : _ _~u-% iS AN EXACT ' - - •
V ~ruF*HSR-,,•.•= ;~r,:r:•::;: ~t~~;_EtNTHE
•ARTMENTOf ~;E_ - . 111;:,rQY.'N,OHIO -
l^-~ }.rj.,, 7 n!~ 1; NESS MYHh4tUr.i~~..._r.L>..-. LC•~At REGISj1~1ft • .
! l..i,E 2 I ~ • _ VITAL S'fA7'ST iGS. ~ . • .
,~1" e,.
a
sT- ~ucl~ cc~=1+;~r. f ~;'a SEP. 25.19 9 - ~ " •
ROGER PQITr~A~ ' - -
PI COv rln~rn ^r ~ ~ -
- - - '
o .i
T , OHIO DEPARTMENT OF HEALTH
~•.vARCIN DIVISIOMOF VITAL STATISTICS 'F~f•'r '
EO FOR Rp. Dnt No. ~ L,_ Sua FW Na _
•..?A CODING ~ D.rnMr Rp D.R. NO. ~-C OO/ CERTIFICATE OF DEATH 1 ~ ~ ~ ~
OECEDEVT-NAME Fti•lr !IJJIr fan SEX DATE OF DEATU p1?, Uay, Yraq -
RALPH J Ai~~ES ER_5_K1N1•, ]Male ,July 27 1979
- RACE-te,.,1M.~:a,9~act,Ameri- AGE-UR 9..IIWr U'aDER 1 VEi1R UNDER [ OAr OME Of BIRTH fNO-.fb r. Y..J COUNTY pi DEATH •
cM Iro..w..rc 1 .SCr. r1.1 lYra•rt ?b[. 1 U_w Rp.•.+ 1 Al.n[.
- '.':hite 67 So s<. 6. Jan 29 1912 i~tahoning
CITY, VILLAGE OR LOCATION OF DE ATR NOSDITAL G'R OTHER INSTITUTIOY-Name (/Jwor4 NrMr, prr rnrrNwJ wwNr) IF RD$~, OR INST. In6rcaea DOA,
OP7Emer.Rm Inpal:en[(S?rNly/
- ~_Youn~stown ~T~t. Eliz NoSp tledidal Center „Inl'_a_tient
STATE OF BIRT.r /1J cur a E'.S A.- umr CITIZEN OF WHAT CUUNTlIY ~-ORIGIN OR DESCENT (Ita'.a+, Mew.can, German, fryl•N, CuD+n, SOCIAL SECURITY NUMBER
r.w.wl..t ~D..ertoR<.,..~I,Spr.-,,y, - 2$t~ 09 $106
I f
ea Per_nz USA 9. Scotch English Irish lo.
-uES ^ENCf riAS DECfASED EVER IN V.S. ARMED FORCESt MARRIED,NEVER MARRIED
~SURVIVINGSDOUSE (lJ rrl,(Lr wraifrw wamrt
'CEASED f)n, awo++! 11/yrr,ftar Jana olxMrrt W~DOJYE D, OrV~il'E ISDrrr 1
`~~..-I~ATR '"pro ~,]a rnarrlec~ i,A hiar~;aret Einn Yeckel
••'J IV - -
' GIVE USUAL OCCWATIONfGnr RrwJD/..>re Jowr Judwr mmroJ r.vE w, a/r, r•rw grrrt•rJl KINDOf BUSINESS OR INDUSTRY
erFn•!E
Truck_er O_w_n_ed and 0_ot~_~_ated Own Trucking Co.
L~~ RESIDE VCE-STATE COUNTY CITY, VILLAGE OR LOCATION STREET A`1D NUL!BER INSIDE CITn LIMITS
Ohio t4ahoning Lowellvilie 6210 Center Rd. 'S""°~oA"
lea. t ID. l e<. 1 W l1e
FA Trr[N-NAME F7nr SlUJ/r Lau MOTHER-MAIDEN NAf1FE Erru 11aNtr lur
is Ralph James Erskine ,9 Dai$y I~Iound
j ~`F OH0.•AV T-NAVE /f.,-e a?.ewq MAID VG ADDRESS ISTREEi OR R.f.D Nol ICITr OR TOViNI ISLATEI QI?)
~ - „a i`irs R. James Erskine '~,~.0 Center Rd. Lowellville, Ohio 44436 .
I J ~ AvPROXIMATE INTERVAL
! DARE r DEATH WAS CAUSED BV: (ENTER ONEY ONF CAUSE PfR LINE fOR /sl, /61, AND Itl( 9f TWEE .ONSE T AND DEATH
i 8 //n,.
IMMEDIATE CAUSE 1a1 ~ c-~•~--~ 8'-~ ~r~-~ -
- DUE TO, OR AS A CONSEGUENCE Of
CowllAOwr, IJew)., whkA
scar ntt ro uwnrJ:atr ~ IDI I
u:.rr u_awZ rRr r.r.Jrr- DUE TO, OR AS A CONSEQUENCE Oit
1 f)'Iw[ U+1! Earf ~ '
fcl
DARTrU.fOTHER SIGNIt (CANT CO DiTIUVS=COwJIMwr rowrMrrlwt roduM wF/o~r rAerrd ro/~px,rwwahrtlp) AUTOPSY WAS CASE REFERRED TO CORONER
G~`I.rrd• G.' ,y.-r~s_.-y>:`-rc---~~! !Jr<'~-rc~,r•P rYr,...-„ isrrnly Y.,o•rvo,
ACC SUICIDE. ROM., UNOET.
O~ 4TE
OF
INJURY NOVR ROW INJURY OCCURRED /Ewrr• warr.r aJ lw,-..•-J•w- h•r la. Pi.t ll, Irr.w 1!f
- OA 9EVD~VG INVEST. •Spr:rb! !)f_~wra. Uay. YU•( -
_ _ 70a ]OD. ]fk. M ]Od.
1ti J'JRV AT WORK PLACE OF IEaJURY Ar Aawr, / nw, xan, /xray, oJltrr LOCATION ISr.rrr n. R.F D. wo., r/ry M.a4,r. rurr. c4/
(C; r: IJr )rl or wot ID/Je, rf: (tprrrJY/
]Cg
_ To De Co_mylet_ed Qy A_T_T_ENDING PH_YSICI_AN_Or+ir To be Completed by CORONER Only
]U To •`e Dnt oI my Lnow;e • dea .w-rM - t e emr to an0 P'a[f aM Dee Io Me ceaa!Id ]Z.. On me Da{~1 01 oamManDw s
J o• .~•r+t.
ya!,ow, my Dp.nyn wnn OFNrraE h rM Yana, 6m
+•aIN. an0 D'Ka an0 b 1 Io rr• caul l+l +rnea
(SV+sn..r.wJ]Trtr, _ iJ (Srtw.rrrr.wJTlrlr,
DATE SIGVED (a r, Yrarl ~ ROUR OF OE R GATE SIGNED ftlo., Dey. Yro) HOUR OF DEATR
1
]le. 7 3 D/79 ~]IT. ~ /U ! ~ F. ]]D. ~nr. w
a -
?RGNOVNCED DEAD (1fo., Day, Yrart lPRrJNOUNCED DEAD /Hor•)
7]e. ON +77a M M
VAV E AND ADDRESS OF Cf HTIFIER lDRVSIC IAN OR CORONERI ITyyr o• Innry (Sr•urwR ED n¢, dry o• •ruaar nu4ly/
]J .
8uI11AL, C.REVATIUV.ID4TE NA•.•E Of CENEIERY OR CREMATORY LOCATION (Cuy. ni/a(r, orrwwryl /SurrJ
D T!rFN ISDrrIJ•! ~
9ur~a 1J~uly 30 19~,~ R_i viers ide Poland , Ohio
r NAVE OF cV9ALMER IUC R-.1 FUNERAL DIRECTOR'S SIGNATURE P ILIC. NO.1
I^ 1 FUNf U I ~ AT ~DDFrES' h~i-1F (STREET Vli r l rl (STATE IT
2M1
~~1~nninPhar~ FunQral HQm~,~Z9_ r Poland. Ohio 1~1~S1t,.
~ ATE RECD 9r ~REGISTaAR'S •r E ATE PERMIT ISSUED SIGNATURE OFD RSON ISSUING PERMIT GIST. Ne.
0 17t.
1
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