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HomeMy WebLinkAbout0481 ~ - ~ v.r- • / ~i • Slaa et PloriTla CSRTIFlCAYE OF DEA'XH DepaEIrTEMTEt of HNlth and Rehabililalive SeETnces sTwTe rttt ~TO:_~-._ • VITAL STATlSTIi'; F L O R I D A - REf•TE:TRAR S !f0 a TYPE OR PRINT OECEASEO-tVAME •t•• ar«t .•TI STt DAIT M Ir.TH •+rrt+. :.••t = 'N _ Nat stet __V_e Fernandes TFealale _ !~a 18 1978 BLACK INK . awCE ~..p. W4F•...Nf•cw MM.r• AGE ..1• M+M• ..f•t 'v!f~f_. M. CAI[ Q! WIN.+O..=r M.. CCMM~tr O. OI AtN 1K • Hltwt t Wr••• • n•tt• rpt M•t rwY•1 r•t q•t ~ - - White 58 , Oct.l, 1929 Broxard I ~ 1 1?l,~O ~A WN iiEA1N ..fw cr. cwt MOSfOAI p OTHER NS11T{ft~Wt-M .n w0+ w f•wrf• 4M PMP w rwtff ~ 1t•trt Ht M NO w •Hol2ywood ~ Fes „ _ _ _ Memorial Hospital _ _ 0 SLATE EIa1N a r rot r t . , r•rt n4EN OE 1MIMT CEINMRT MARiREO, NErE! MARRa?O. STIRYnN6 S'OIJSE .r•, Owl r•Mr r•rt . - tOrMtttt f 10. O t t?Krn ' at-~•~• • CotDtectiout • USA- lame ~ _ D_anald P. - ~=.u r w.a SOCi~I SEC~JQty ?iliA~ER TIS114L OCC~wAlg1N .G.t iw a .o•a sow wars rOft w uNp CM RUS~+ESS OR M+DiISTiY - - - - - OCC+A.. NOMrt. UM, Mr r Mttt• t . Own 040-12-3i9b _ Housewife 'Or'U'Oi - RESR)ENCE-SLATE COW+tT CqT• TOwn• C1R tClCwnptT - r•w. c.oirrs• siRtli iu+0 Mwiia - .ww• •tt•a w It. Fie ids Braward Hallandale - ~ ,t,..yes ;y ,324- Lakeshore Dc. IAT/IER-owltt acct w+tttt tas• rwT!!t_a.uotNauaE r.tMt • Silvio Valentine Rapt:ael - Callucci T•NQEyAAMT-NitME KAtING AODTIEYS ttNttt~. • rD. C•t• O• gr•ti n•p. Ir. Th Hr. Donald P. Fernandes Tw 324 Lakeshwre Dc.• Hallandale, Florida 33009 IARt l IEMEf p4?-CavE,CAUfE-N! 1R•0 i0l NL AL AND h •trtOt""" • - OEwiTT wAs CAIlSEO Dtr: !I tetuor o..wt w r k _ ~ ~U fit! AC~'1 ilO~r+~.f toaM•Prt. N •.w, /S/l ' / ~~~~~1~~. / G .S~ - ~ t I`+ uatM•t• t•ott Nn, Nt tp, a at • cwrftOtaKt - - - tt•NNO cwt •1Nf? tTIN~ t•W t•tt _ . k' - k~y 't+ ,~,~,yp`~~ly D Grp ~•tit / _ - EART ¦ CRT1TEl STG•21EK1WT CO•tOTT10TiS: eatwaatt taw Rw.~ •s.e.r to wt n• w twat war ........M AtROK+ M TES ~e.f . •...a, - - . Mt My~rO. YNM• it Mt ~ - • i?io a N•tr ~ N• KiOE:~OEtIaMMAO nu' _ Npw MIWt OCCYRREO ~ a~wf wwwt of w.wf. w •ur ~ o...n r, +fr et • i la+1 Rw.•aM E soot ~ ~ ~ M ~ Oy TdJURT AT .TCR[ MACE CM IPIILAT •t row, t•a• tttta, ttctprt, tOCA110.1 . swn a • r • ro . cNS a cast, st•a. - ~ t ftttttt ttt d rot ONKt tl•G . tt tlttttt• t - ~ ~ - ~ - ~ CERTT?iCATTOtT- rO.at •s .ta row! w• qu w• t•. rr:.t• •u•t or . M.'ee •o..•t. at QEittN OCtottt0 •.t +..at. o+ ?wTlKtstt: EO ap.•.. ty. .t.• ap..ntt M•.r t aatWt• tw r r• •.r>nt•r,. «ct.ue tw./~ ~ [Tw 5-I8-78 :a Ta. 6e 40P« •Q -«a..~- CER•KKi~tgN-•09~CA1 EawwNER C!R CORCINEt o.. p.t t•t•t a M ro.a o~ tt... t+t •tctea.• -.t •.o.ou.tto at.+ - a ft.-....W Ot t0.M •re!Ot M ~it:.~.•..0••. w r• O•tr0••. - .[r•_ f.• .p.• - t~V OCtMM• Or UY. Mt er•..1! q Oq t••ttW tt•Nf _ _ _ ~ CERT_TEIER-NAME tm! oit+.n - S1GNA - «~Kt 16~TE StGNEO wz _ Stephen Gervin, H.D. „ May 1°.147 NARMlt• AOORE3S-CEIRpER ~ - ant • n • e ••o r ' ~ y.n . - - 3700 Yash~n ton Scree •r' ~ yT+ood Florida 3-}~21 ~i, tUMAI. eREA4AT10N. REAfOVAI TER+ OR eREMATOR+-Null[ eOCA c••. O. q... - s•.-t ~~"r~(J tsntrs. ,y ,q Ho11yE+ood I~{eaorial Garde ~ Hollywood Flor--ids Burial----- - I' DATE .ro•wr. w- .tu. ipMERAT NOttE - aAW srop ADMtiS t•nt. o• a ro . c•* w •o-+. s•.•t t.• . ~ - ay 22. 1978 Fanciers Hemorial ib[ae~ 4200 Hlxd. Blvd. Hlxd. Fia. 33021 V.S. ~f.T2 f1RlER --af- KG1STlAR-LGIJAt~t O•t! tlCt.+tO t+ t0C•t tlGlftt•t FT.v. rnEi ~ - ~ -r Sub-Req - , ~ ; .t...t.ar.. - - ,r r, ~ - ~RDEO IN THE OFtIC1Al' RECOitQ; 8001c -~•3t _ ~ • - - Of BRQMIfARQ iXIUNTY. FIQRIDA "•n ~ - ~,1`' .::~t•~ - - - - _ - GRAHAM W. WATT ~0 i •r ~ ~ ~ ~ - OOUHrr AuwwSituTOR - ~ ~ > - , f^ CERTIFIED COPY - ~ #~2-'I ii~rgbX;certf#~ the above to be a true and correct copy of the Local Registrar's ,,,rec'ottd~ an f~I-g ii? the Broirard County Health i3epartment at Tort Lauderdale, Florida ~ arning - liot valid .unless raised seal of t Brow rd Co y R lth De .is afflxe'~ j - . ~t County Health Of icer and Local Registrar i - ~ ~ 10-19-79 - - f ~ Chief puty Local Regis tar - _ - - - - - - - k R_ET[JRN TO: R-ICAARD PER.LI_NI, ESA. - ~ r 1943 Tyler street ~ Hollya~od, Florida, 33020 • ~ - - -