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Stara of FloriEM CERTIFICATE OF DEATH
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CEIDNE+-NAATE tlr,r Or,dwn - e O• r T s, etr,reu~
z>. William J. Richards, Jr. M.D. >w ~ ~ TT. _
w?iwG ADIIffSS-CE+tt~fE+ gMrr p a•.e r.0" m ftq
:y 1551 West Ba Drive La o Florida 33540
ENRIAE, CA'EAfAflON, ~EMDVAI EMETEty O+ C+Ew?fO+T-NAME lOCnr10N pT? M q.» frn
Tfwcr7T .
H• Ento_r~bment _ . NfSe~sn~ty _~~~_par ~ Florida
O~tE T ryrr, Mr, a.¦ , EyNERAf HOME-NAME ANO ADO+ESS ~ fmo o, ..r.e MO , cm Or ro.», fun. w .
t„July 20,-1977 ~ Tf.HUBBELL 499 Indian Racks Rd. N Belleair Bluffs, Fla. 33540
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rv+Ee ` ~ RECIST+,u o•re eecrweo e. AOCM aGTSTe•e
~ , 1875 >w ,.t 7' ~ Jul 18, 1977
A ` ~ . ~ 1$y~` CARRY THE El~BOSSED SEAL OF THE REGISTRAR OF VITAL STATISTICS
T • /
r Certify that this is a true and correct copy of a certificate
~`i4 the office of the Local Registrar of Vita! statiatica of the
~ ~ _ `l~t~anty Health Department, St. Petezsburg, Florida .
4 Cp e~'r` ~ ~df~'~1S- . ~~'~~~~(1 _ ~t .Deputy Local Restatrar
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4E7S9'~'2~ fE6 13 AE{ 2 I
F 1E0~ANO RFCONOEO
STR06ER
P~OITTRA~A
CLERK C{ACWt COUR'~~Q-i-,-i- r
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