HomeMy WebLinkAbout0411 4`789'70
' ~ ~
CERI~IFICATE OF DEATH
~1rT,rdn1•Id u) ~1.,~111 wn.l ~.{L.L,Id.llilr ~rrlilr• !/TATE RILL NO._ ~ .
IN\I~N IT IN 111/1111 FLORIDA
•vt „R IdNI IN GNU • ftEG16TNAN f NO
/ItMANINI INt SER DALE O/ DEAIN ~ rtnru, p•r •~•r.
SIE 'U\DEINII /p1 OECEAS[0-NAMI r,apr 1.11
~ Edtr:~rEi _ Daniel _ _ Silk_e__ 1 Nale 1 F`ebruary 21,1976
RACE ...n...wr , •rr e,.•n .wpur,_ AGE laf, «_!+Da 1 rl.a u..OU r e_.~ CAfE OE l1RfN ,.Onr.. o•., COUNri OE OEATN
nc . 1na•. , nal«o•r r raN, Iws o•.1 ~ ,rw.aa ~ ~ r1•a ,
17hi to _ _ _ _ 1 +1 June 14 1 04 Broward
CITY fOWN, OR 10CATICIN OT DEAIN In11D1 er1. lrln NOSMAt Ol OTNEt NSTITUT1pN-N Iw rpr ,n 1lrnea. GM 1rMe1 •rO nyrNa /
I / ~1 fret M• f11 Oa MO
• ~ P1~mbroke Park es _Communit_ Hos ital _ _
SGIE.OI Wl1M
urn not Iw u f . ~~~I CIT12EN p W~111? CgJNTtY MARRIED, N[VE! MARRIED ~ ;StMV1Vl1E• Sf01lSE ~+r rw1, On1 Wo1M wr1 r
CCyr•rar ~ wEO. OIYOt O 1 wcw r
,.I~•1 a1f«~• E Ne~v York U.S.A. 1.~_
a_ rri_ec~ !,1 Ruth E~idy
•~or ou of ru SOCIAL SECUntr NUMtER ~ USUAL OCCU?ATION Iw.e fro or •+Oar ponl ownw rplr a ~KWD OE fNJSwESS W 1N01lSnY ~ - ~ ~ - -
occunfe .n ,rda,wG un, I•!n u aPUf01
1: OB -26- 1`30 Ib Policeman _ _ _ _ _
nl~oenCe NrOat ~ _ _ _ _ _ 1)1 PoliCie
•0"'11'0'• RlSIOENCE-STATE COUNri COY, TOwN, Ot IOCAf10N rnl.oe an I,rna SitEEi iW0 NUMIE!
11?u u. I 1 w «o l
11T~lorida Ie1 Broward 1« Hallandale 1./ No ,..225 ~7. L°1ce Urive
fwTNER-NAME pq1 rlppll fyr MOTNEt-MADEN NAME pql rr.OW1 Iwar
1! Julius ;ilke Julia Ristflu
I NlORMANT--NAME MAkMIG ADDRESS lunn oa a r o rro, ur• a corn, a•n, Ilvr
1,. Ruth Si1ke 22.5 W. 7,ake Dr. Hallandale, Fla.
R'UT I OEAM WAS CAUS[O f1Y CENTER ONLY ONE UUSE IE! IMIE iOR (o/. TAL AND (rq • r ur• w ea..,
_ Nnr,len Oryat •M M•'
,R rWpuil c•Yf1 - .
Cora~,ry py_lmonalc 1 year
con ow
conpmons, •n•,
~MI(n o..1 .If1 .o (.f _c_hronic_ obstructive pulmonary disease 5 years
Irreeuq c•yfe la, py1 ?O. W u . (On110uIrKe p:
LI•IIrG IMI ynO1a-
1r,r0 (wYN lair
lel
?AtT ¦ OTHER SK,NYKANT COND1T10lIS' Cplpnonf eorwerlmrw q NwM ayr nor alure0 r0 C•y1a GI•tn In rear r 101 AUTOISY ~ YES VIN rlnanoa co•
cirrhosis I.e1 0. rwr LOlaep In Mrlarlnw0 U,ri
a ee•rr
no
j?. f ACUOENI, 51i1CIDE OR ~A~~- I rout., yr1, nu / NOIRt NOW INWRY OCCURRED 1 Inn• r1aNM G rn.ya• In ?•n . M ?ur n, rrer ra .
NSOD.MCKIOE: M UrQEtEW1NED
7a 'Irl Tp 7h M ?Y
_ ~
j IN1UtY wi wORK PIwCE Oi w+MY nor1. ••ar. uae/r. r•c~rw+. IOCAhOIJ 1 fne11 oa a ..o no.. eln oa Ion. sr•n r
J r N1CIN •ea q n01 OrrK1 aloe . aK 1 SNCIn r
~ ~
CERTIIKATION- ro.rrn e•• •W i rDMM O•t •I•a wlrp V1r f••+ nr/np •1,•e On , DO!plp nor •qr tw DE AIM OCCWttD •1 Me 11•ce, O•- r.r
/MYSKI•N[ SO ronrn o.• nu aoo..rna N•rw ,noun o.n, w•q. q n.r rn
1 •rreneto T.e
I~ Q ~7 lS '7 ~ M r• anprrlDGf. G'.
T1a oete•fID raOr L 8/ E ~ ~1 ~ 1 ~6 tll L L0 I )la ~Z u is v t ~ Q 5A M t0 era t•«1t,1: Sr•n•
CERTNIG?iION-MEDICAL El<AMINER CIR CQROI.ER on •we a•f,s Or rue Hoye W q•.1 rue pfCegnr .•1 vaO.roy.rCeO e1•o
I a•rw•non d me aoo• •np/Oa rly w•I11K.•rlpn, ,n w Orur.pn, rOnrn p•r •e•a soya
01.+. occwaw on rre o.n .rro oa ro /w uyslly 1r.no
CERTiHER=rvwwnE .m~ pa rnn.. S~IGNA~RE~ 1 oewu a not-TORTE SIGNED .rorrrn, o••, nu,
t>. Jack_B. Dri:nrner ~ ~ j_! r ~ s~ ~ / 1~ = - .
MAKWG ADDRESS-CERfYIEA 1rNIr • r o wp t ~~(I~a rpwa fun t..
:x 251 I;.Iia7lanc~ale Jneach B1vd.Iiallandale Fla. 00
tlRtlAl. CREMATION. REMOVwI CEMETERY OR CREMATORY-NAME t IIC/N e,n d Ka_.. sr•ee
;N '"'Burial _ Southern ~,em~ Park Liiami, Florida
DATE . ~C~'•,.1"~~~_~ - ~;"?iaa~"ington w~reaver' 201 YJ.II3eh.I311v$.Hfllandale, Fla.
•F 1 - JNERw: OI ,TN ~~f REGIS Ai-SIGNwtUtE ~ / D•r1.~c fr_I AY 1tXJ1~EGl1nu
ke..:~~0
~a-''~'-' ,w l'!~..1_J_C. r~ ~X .;I.J{',V`r'f ,w -"I.l..Z,, c2`l % l_
i
~
1 ~ . .T ~1 r 1.1'1:1'1 1- 1 : 1:11?'i
;
~ 1 = ;1'.
1 hereby certify"LtIEC~ ~p~.~to be a true and correct copy of the local Itebistrar's
record
oA=filet i~q t)2E: _l~bTrard County llealtl~ UcpartmenC at Fort iaEderdalc, Florida.
1. II
I.- ' ~ .
(Warning-Not val~id.ut~1,P~8 raised seal of the Broward County llealtli Dept. is affixed.)
. j y~
2-26-76
ou ca t~ y er an oca egistrar
Lrepli::y ca egist ar
r .
- _ 1
4'789'70
s ~ IUIR t 1 AN 11~ 41
~o ~?~cp~~{col~o
At
~TRA~~.
r e
~'.QEntr lE0
~~x32? ~~~E 410
_ _ ~