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CERTIFICATE OF DEATH "D'
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oAnrla FLORIDA uw nu no. 672
TrEt oECEOENT-NAM[ Elect rlDOlt IAST ux DATE a oEATN/ra. raq, r..l
a,,,,,'",,,.,E E. Betl'Ii0@ L. Hurl F~e[[tale . Nw. 25,1979
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6602 ~ 79 ~ ' ' e- Jan.29 1900 E•-St. Uycie
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iATME[-NAYS *~HL~Si~ MIOOIE 7~~~IIIF ilEt-aU110EN NAME u,E,~IK~i M~ODIE Tw~~,T,,Y
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INEO[WWi-JiIUfE Il1.I. r hr') Il#1G AOD[ESS Si[EEi O[ li.D. NO. dTI Ot TOWN STATE Z'
17a. Artlwr J. Hurley f7f+, 31 Tangerine Avetu~e• Fort Pierce, Florida 33450
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1... ? IEa. Yates Flutesal HCme InC. Fort Pierce Florida 33450
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' ~ DATE SIGIlEO /ra, 0•s, 1.J OE DEAIN DATE SIfj1ED Ira. A... t•J NDUt OE DEw1N
f >o.. ll-26-79 2:10 a. M ~ r._ r~ M
NAME Of AiTfND/NG h1TSICIAN Ii OTNE[ 1NAN CElTlfiEt tT„. r ~rrU = ~ E[ONOUNCED OEM Ira, a.,. 1..! MONOIINCED DEAD /rr'i
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mod. TIA. ON JI•. AT
~ NAYE AND AOOtESS OE (Eli~Nft pIIT[iC1AN, MEDKAI EAAlA1NE4 IT„. r,.w1
William H. Meyer, M. D. , F.A. C.S. , 2215 Nebrasl~ Ave. , Fort Pierce, Fl.
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[EGISTtAt ~ „ DATE eECE1rED n eFC~steA[ .ra, D4. r.J
aolsn/Tlofs / C! ~ / n.. November 27 1979
i IE AM tw 1MYEOIATE CAIRE IGtI[2 O.tLe OA[ CIDSL 1Q LIrE EOA •1. I.1. A..D /r1-I ~ I~..+d [.i.... wM •b
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.ALT OTnE[ W.WIfICAFET CONDITWF4-lw.Mr. wwyMU! w d.•A !M •M wMti/ 4 s.~~.l"w~ E. f•AtT f M AYTpSr tslr•/r WAT CASE f[EffIED EO MFD~(Al
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E~~,,~~E~~E ACCIOE/tf, S1/KMIE r DATE OE ruutr frw. Iq. T•J Ndl[ OE 1fMIRr OESOINE IIDW WA1[r OCWRf[D
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INAI['E AT WOe[ ISLAM, In MACE OE INAJ[r-IH trr. lr.~. •nw, Eecwrf. •pb ~'e• LOCATION STtEET OR [.E_D. w. Gtr Ot TgMT ST1
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FtlfU r:h CEO
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~ ha»q? osttlfy MtM to be • frw and onrna oop'y Ot the tA~o R
~ Rapistrars rroord tm pM M the St. Lucie County Flaalth DeP nCt E ~ ~ ` "
rrsnf at Fort Piar+a, Florida. i~ECC~~ fry
(VNaminp: Not valid unlea wised seal of the St. Lucie DEC I I] 45 ~ 1
County health Oepeftment is affixed.)
45958
N. D. MILLER, M. D. -
Counfr Flealth Officer 6 loc 1 RegisfreT
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