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Palm Beach it ~ ~ ~
. Coul y Health Department
~ CERTIFICATE OF DEATH '4~~$s
DeartwcaE.d Ifn1TL eltd RelreblNeurre Ser.ke• RwTS RILL NO.
EllvsloN of TfaI.TT~ FLORID A
ir?E, OR fMNT IN rw•Y~wt••et•s~tto
REGItTAARI•• NO.
1lRMA/1IN1 INK DECEASED-NAME nest rleeu test SEx DATE Of OEAM t roNtN, e•r, •e•e t
SEI RYNIOOE f0~
'n'~101s E NaRbtAN WEISH Jr T ElALF ,December 2 1 6
RACE rrrn, Neoeo, •welt•N INet?N, AGE-t•st v«eee 1 nu YNwe t DATE Of RRYM IrO1rN, a1•, COUNTY Of DEAM
nc. t s?ecNr / www¦ t.e•es r ros. e+n /Iolres rel. rlwe 1
~ 1Rhite 63 . Liay 17 1913 Palm Beach
O'O CITY, TOWN. OR IOCAtK)?I Of DEAM wslet en trln 110Sf1TAl OR O'.HEt RYSTITUfK)f•I- IN IrOt /N errlNe, 6t!! stem •?e NtW!! r
sncN. ns a rlo
T. hest Palm Beach Yes Good Samaritan Hospital
STATE Of RM1H 1 Y NOt w v.s.•., N/u! CITIZEf~I Of LARIAT COUNTtr A1Atl1E0, NEVER MARRIED, SIIRYTVRIG SIOUSg 1 N t.rl, oNe w.IwN rl•rY 1
Vty.t !!sOlNQ Pennsylvania ~t U. S. A. ~a"/Orr Dl'r"~1 Norma Mundis
„nu wut~wel SOCIAL SECURITY ?AIMREe USUAL OCClMAT10N lol.e awes noes eo1N ewl.w Yost a RRiD Of RusR+ESS OR RIOUSTRr
c CCUwlO w - rllOeew6 lW, tMN N UtNMI
„ 175-10-8989 ,y_ Proprietor lgelsh's Marina -
•o+lsslor•. RESIpENCE--STATE COUNTII Cllr, TOWN, OR IOCAiION YISIM cw• trln STREET AND N11MRE!
1 srlcNt ns W NO
,..Florida ,y 1~artin Jensen Beach No ,w Beacon 21, Apt. E - 5
fA1MER--NAME rust r1•ete ust MOTHER-AIADEN NAME nest rleel! 1/tfi
~ „ Norman V~elsh, Sr,~ Florence Householder
IIiORMANT-NAME MAIMtG ADDRESS Ismlr of e.r.e. lw., crh w ro.+•, sun, trt
Norma Welsh ,n Aeacon 21, Apt. E-5, Jensen Beach, Florida 3357
TART I. DEATH wAS uusEO Rr: (ENTEt ONIr ONE uI/sE ?Et tarE rot hl (bA AND (~A Kr~le/1 ortut •rl•
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IN1URr Ai W'Ott( PEACE Of NA1Rr a Vow. r.ul, sreeo. r•[toet, LOCATION 1 smn oe e.r e. rq , em oe to.N, suw 1
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CFRIIfICI?iKki- .loNrN Mr n•e ••ONwI at n•e •r4 usr s•r Irr/Yfe uM ON 1 ele/OO Not wl.r Nlf DEwTN OCtveEO •t rNf rt•c[, oN A!
1N/SKt•N: ~ TO '7 rOwrtY • rte Boer •rtee o!?ar. 11•pY! 1 e•N, .Ile, q w els+.
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CERTIfICAT10?J-MEDKAI EIAMINER OR CORONER oN rl~e usls a the ~ , M to tIN t:wsent sun•;
NOW W 0!•M tY! OK[elNl ~U re0•IOYNClO w•e
ti•MN•g0./ 0/ PIN coot u•O/0e PIN INr[SrIG•Il()N, w rf pwpw, rpnN er n•e IIOye
wen. occunw o» eN e•n aNO out to rw c•uslm steno
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CER11f1ER-NAME rrtrt of rtwrl ~ SIGt•IAT M
wen! a nn! DATE SKI?rED Irpww, w?, rwr ;
TTe ~'cllvi/%I V? i,vc ??n/ rJS < - -~~tC~i-`ic' 1'1-le~'. - - ~ -
HARING ADDRESS-cE•ra,ER 1 2 North tFla ler Drive Westl~l~a~m Beach, Florida 331107 'Ir
RURIAL, CtEMAT1pN, REMOVwI EASETERr OR CREMA10Rr-NAME IOCAiION un a ro..• sun
1 trlCNt r
r~
~ T4 Removal~_ Jn Uount Rose Cemete T~ York Pennsylvania
DATE r IIONIN, e•., n•r r fLINERAI HONE-NAME AND fSS r st u ! ! r.e. o , cIr? o! torN sun, v 1
.i December 26 1976 ,s.A cock Funeral~lome, ti1~. commercial, .fensen Beach, Fla. 3345"~`
v, 5. •b 12 rui+ ~ ~ own•~ICelrrEO et low etetsTeA•
t•v, 1970 r' ~ ~S SIGNA l /
n?~11• ~•tiA'!"i IM. `~°L~1 tN .2`7r.r~.e .i, ~fl /
I HEREBY CERTIFY THE ABOVE TO B$ A TAUS AND CORRECT COPY OF THE REGISTRAR'S RECORD
ON FILE IN THIS OFFICE ` '
1 (Not valid unless. the seal of the pal~;Be$ch"County Health Department is affixed)
~ .468586 ~T.RUCCIE Ca..h'~ r Fl~,
~ CLEFs~.:
RECOp-. ~ T
December 30, 1976 C.L. Brumback, lf.D.
6 2 is PM Loral Registrar
• nAM1 wAwr ~f J~ ~ .
Rnrn~.. .,F va ~..i o~_..i _