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HomeMy WebLinkAbout1346 , • 4~rJ666 1790139 DS Tl11. i.• ..~,e mar 1111 CER'MFiCAT6 OR DEATH ' a.w.. • wllsw 1111M1~ ~NIYM1os R,a~s wlrs Ila, 1• •1 ns• tLO~sn~l ~ Qrf /r•~•rlr 1. KAAt N MA/MQ__ NO? r•rAA •sttOiNASlN7a.aw.IM~ t.MlwMwrpl~.~i1.r.MAr.•/.IrW aN gill a• COINITr i~'W~ STAR i` L~'w~ i• ~la•N I' w t•/- cmr. T011n1. oR 1fDCATgN s. s ttAU o/ OEATM s. C1T11. T0111t O11 1ACAT10N t. waw•wt ~ NIilOE cur lMlfyt NIl10E C1Tr L1M1Tyi ru.• rES No ra NO © ~ .1TIR OIN1 (w~ia~l Nae YT~cT 60 IueaaE Da.IK~ .1 75 11Awa1.? ~l?te ~ iae s. oATE abwll a n.e i ( Fw.ed !lE.ld ~ lQd~ uX COW-~A~I~ORa~~AA~R 1. ,,,Altl„[O ®.[rEll MAMftO nO~tL1R~ 0/ .M.M . AiE ( ~ 1Id. ,IDOL. ~ iDlb~a: MIOOrrl11 o1MONCto NCW~ AMt «Mb Nwa w... xa.. i • r ! t • ~ p ~ as • a / 11111AL OoGNATgw ((Otte !Iw! ywrt ae.. IM. IU00/ tANirltlSON NNIYSTNr 11. aNTNrtAeE (tlw •rMM Nwwa/) i111M11 ar ~'ii/iTCtt~i •1111 *•r- wtlty~MwM.•1eRY/MM ¦ aw•wt /uyp~, flask iNk 1 / •S tyyt _ _ J MlOT1~O'S NAIOItI NAtIE tr*••ria•r Famed /Ield ~vla • MAS pEC[Af[b E11E11 w Y. ANMEO t+ONCESt !OCHE lEttlNlTr 110. 1 t1/111? /tote e 1.wae..a.Msw1 wt..w....aiaw./asrtia ~9~-o9-~S95 .1..~t. 6D _ /rw•ral 11. tuwt M t1iATN f111w •rt•raepr /r . K) o~NeKT~„TM air•tt•! MATL O[ATNMASCAYpOwi .••t tll• wNEOIAR CAWE ca• s•r- _ clrl.ae• U t1uE trs p) o •lc~ tA• I • • a 1 ~ Mme e~w/e?~ r•Ei•trar a>rtt OyE TO (d 11e•r •w t' S rART IL 0116 l~lvwt Oofw1101s OOwIf~11wN 1o OtA/N t1R wf OBAIO 10 M 1Bwwll 01ffA1[ 001~111w i11O1 M fMT 1(al • /[aFOQM[p t•t a•at11 rES? NO e r t•r• 10•. OppN N01/ wtuNr OCCIIMEa (8titw wa1•re yAylar rtt Ar! I ar ~•rt 11 yMe.111.1 ¦akiws ur AC[IOENT s1NC1oE NOMIdOE a1•.••1• D O ee•w m,r. T1ME Or /pa Xw1A. D•r. Yar sear. ~ rwNr ~ w. mt NlNlwr OOWNN[0 IAr. RACE Or NINNY (t. I i1 N attrt Msir. ~ Crtr• TOMII.OR LOfAT1011 OOIINTr STATE M111IE AT D NOT MNN,E D Nw. fNNer. tI?p1. t~ ~ti ttcJ MONK AT MONt: _ - !1. J attwNI tA. /....•tt1 n..1 ~ sa . ro awI Aut ..e. ~ .a.. ew DwtA •eellteai at ~ w aw t/I• Iab •tat•I wMr•: awl h tlw ba•t e1 q Awea?Naip. /rew tM OaI1••• •tat•I. All it•Na •r• i• i• tra f1a111A (~«K ) ~tt'~'_ r lit, fMTESICIIEO eawrl•t• ti r ~ . 11p 11 a•aarat•• 2Ia. CsTrAtlo4 DATE . NAM[OiCEIKTENI?ONCNEMATONY tl/. 1+OCAl'ION(a/.Atltw.ar•1••l/) (tialr) ~v 2 / /11eo ele o ~tarlrta .•.~als tt., 's ts. a w1~xN•a CERTIFIED COP7C I hereby certify the above to be a true and correct copy of the Local , Registre~e~s,.reeord on file in the Brorard County Health Department at• Fort. ;;T,~u~ekc~cle, Florida. .,(x W 's~~~:~~r~tsid unless raised seal of the Browsrd County Health tent is affi=ed. ` _ _ - F~ I' ~ gtulty Health Officer sad Local 8egi attar ; . fiLEpp ANN0 r:ECOiififU ~ ~ ~ i ~ - ST.LUCIECOUI(TY.ftA. sc = . ~ ROGER POITRAS C%~~ E C~cuiT C Depuf,~r Local Registrar f ' aoa°~~ P~GE~,~