Loading...
HomeMy WebLinkAbout0379 , ` STATR OR RtAR DI A ' 46441 _ Di~A1tTMENT OF ~ ~ ~eaith & Rehabilitative S?~v~Cas DKTRlCT )al.dYBN- DADf Op1fMY IDSlARTNENT OF . ~ t'vttt/~c ~u.TN - s Ns»Ilr c~r:slr ss» so s ~?•~as . N, N, MfR sY: { , ~ oo>rlt ar ~ Loca?L ~•s >~asD MtfAf~ I~,ORID?A btttf • ~ . N llot va id uuleea the raiNd 0 • - " _ ~ seal o! the ~us~eau o! Vital . _ Y+ Stacisuaa is of iixea. VTilAL >~COIIDS QIIT _ ' _ ~-y.'r"~"''";"'''' CERTIFICATE OF DEATH "'f"'"'r°~----- ` • , ~ i.~si.c^ ~•fa... FLORIDA ?ocu «te Le. ~ ~r ~ L ~ xufrNl -...w /fe•t rfOD,E fAS1 sex MIt a Quiff /M...lw 1'.J ! JAFi~ _ _ E_ . ~Ap1~S MALE NOV .1,1 X79 ~ 1. _ ••p + . w+.~ •u-,.ta ?.+.fa. _ uw_e_e ~ vtu wDt. f wt o.re a MnM /w.. a.?. ?..r ~owr. a a.nf r-..° IM.n ua / ubt T-O~i~ f~iral T~:~ (~T:. itrAr. a louT.JM os oexM ~ Ipelfi~l O~ Ci~M. 1~4i,lUflOr'L-r'tr.r /p r w .r,... M. r.M .v mod.., f; IOV O. Ifef. ~;i _ _ t._JACKSO_N MEMORIA_ L_HOS_PIT_AL _ J1 !7 flxtf O{ Metff ///.r•~ 1rCIT12fN Of rnc.i COV.Tet wtelfD ?4V!! MYti1tD. 9MYIVWG SIO{16e /1)../,, r1.. r..1 - e's w. w..~....r' - w1oOwEd. pvOKtD /s....),{ • Niscon~n 1! _ tL,S.A~_ fl!1ar ii' Charlotte H S.X.., :fafern fifty[! Y9Y1f oCQf?+,tfptf /ir. ..+/./...a r... ~ RMO o. eusl.xss a fN01aT.T M 1M..... rl .w...{ f2 b13~1;2_-8802 _ fy Owner ~c erato ~ tf LDI NCf -iUTE (ON.lI? (.T1, t04Yl/01 lOC~IION Heft •?O .wlltetfl 1 if /s,.r./t td ly Florida f.t,A101~18T'd fPo .beach f 0 S. Ocean B f.l„tt_ .,tt.t tffRi rlDpft tAlT Me--a4?WEN Mrs r:al r.ODle UW -./aNtuVi--w~M /1.~. « hr/ ICUy /~Opf(f{ sfnn a e { D NO uf. O. tpMf!Y Slwtt Zr l~:rs Charlotte 1~-avia 1/.. 0 S.Ocean Bl M~wf. cetwTgN. elatOVxt. Oiffte .s....r.r urtile. 01 QtwiOf?~d,rE iOUiION Unr Oe Rw4 1.. ~a~va~l - f.'t~oodlaxn Ce~aeter~r ~ f«. Nashville • ~t,r: DNtCtOL-~:f / ~ fUhEU,f fOME ~99 N. Fede~ .a ~ fw Fairchild Funeral HOmes F q T. N ~ 1~.. S{v'.~..• ~..M, r./ Z1. Q t~ bv. M ...~.+,..M Y.d'Y .+..M~.M 4}.O. 3 ...,e e.,. 4 w [ ..[...•w M N .,w, sn. w I,+~+ .p If. a.w w+.a ~ ~ .e vueD , r.. s... t.. 'Nax ar oa~l.~ wn s.r+.to rw., w... i - - N01fe Of ptATM i ~~f ~ .lIOVEMBER 2.1979 j>< _ 11 s00P. _ ~ ~ - - ¦ j, watt Cr ATrf*O.NG AI.S'CIW ..OMlt I.,.4 Ctel{.{fe /t... r.w) j ~ ..O.aOt7.CtD DlAD /w.., /tn. t. { MO..O,RfCtD pI1D (wr! f F~ 7Dn 7T. ON 2f. AT M 4 •.?W ~•.D AOMtS6 W. tln:Nt. VM+S.C,.w. t{!O{Cwt 1aIVM{Nt.1 r ir.•.. r•wr - - - . - _ If :2 ROB D. S IMMONS M. D. b _ I .i,, r+.. ~ D.Tf t[cflao n nusTw /r.. a,. / ~ y`. r ,/G 7 7 1 arta.lf U~Y U,i.t n[n ..r,e • n.1 Ian I ~ ~{..r.wf M..w•.w.•.wf a.., i ~ ~ ABDOM_I NAL SEPS 1 S - _-----1--- - - '.r! Tp Je .5 ~ .CY6tOUfNC1 W - ~ , I. r...i tw.r. ..sr .,d d.M i HEPATORENAL SY_ NDROME - _ _ _ _ _ ~.f TO O. •S • C0~6l00.f.{i G ~:"'r~ rLA • DISSEMINATED INTRAYASCULAR COAGULATION - ~ - .A.1 ; i,tl. ....T ~.y{p T{p.S ~ .y b.• ,a a v J t..• ~ ~ 1'ry5.. A•S (.Sf tf {f.. 1'i YiGK1; - -1--, - 11 flux Nf. ~ .,.r. 1.. ..I i CIRRHOSIS, MACRONODULAR ( YES . ..K ~'(t•.' L'.. ri•fr G+vf v n,.. •...-.N 11 aAr •tS.ti ...?~6,N?O(C1..aD ' . .-rw ftY~. •.fo f . ww. ? a. HY w .w. 1..•a a +.'c/. 51?ff' M . { P Oir CN TG..N_~Ar<Te r ~ .a - • ~?6 'p ~ tILED ~M'_ • ~~fD iT.luC~~ ~ ~ : 'tA. ao~;~ - . s CIE~r - . :,Lla IIECOG" - ooc i~ 9 ~ aM ~q f 469441 M~~~