HomeMy WebLinkAbout2290 • •
Land situate, lying and being in City of Port St. Lucie, County of St. Lucie,
and State of Florida, to-wit: Lot 11, Block 1540 of Port St. Lucie Section 30,
a Subdivision according to the Plat thereof, recorded in Plat Book 14, Page 10,
of the Public Records of St. Lucie County, Florida.
t.~ ~ ~ STATE OF MICHIGAN
~_'j DEPARTMENT OF PUBLIC HEALTH
~ 1.33'71 _ _
. ~ STATE FILE NUMBER
1
O O p ~ C O p p ~~r~ ' CERTIFICATE OF DEATH '
. U ~~JpENTvNAEMED ru~i Y~ooEE _ usE SEX W1TE Of DEATH lMo.. Day. Yi.1
~ Vasil Markoff z.talale 3 12-14-79
RACE-Ise. Wwee. wca Anwe AGE-Ea+t Mnspr UNDER 1 YEAR UNDER 1 UAY DATE OF BW1H (MO. Day, Yi/ (COUNTY Of DEATH
aa•.1 ltcl fSpecrNl IYrzl YOS owrs Nans~-Yws
WH~TF_ se sn so. s. t.-15-x--x.91 _wayne
IOCATgN OF DEATH ®w~ GTr EwRrs q • HOSPITAL OR OTHER INSTITUTION- a.rr to •w w e.uw g.w nce+r r+e e.~en
~"k Detroit I
EvEd apeerhl ~ eesloE vRtweE Ew11s a I
Henry Ford Hospital
7D ~ Ot 7c.
' ' YARRiE D. NFVER YARICED, WAS D(CE DI N: EVER M
sTAtE of w1rN rn.b... us w G712EN OE YiMAT COUNTRY SURVMNG SPOUSE lM wr/e, grve maiden name/
..rse cowvryE WIDOWED. pVO11CFD /Sa1cd17 US ARAtfD fORCES~
K DEATH t~'K E•1~N
O[c11R11EO w B 9 10. 11. T2. J
1NSnrurtoN
SEE YANWI SOCU1l SECURITY NUMBER USUAL OCCUPATION /Grre krnd O/1a-dR done dunng nwst o/-S IND OF BUS:fiE55 OR INDUSTRY '
REwItDU.c working bh, even d retoed/
cua.;ElXra of 13. . toe. ~ 1lD.
Rf S~I>t NCf 11EY5 /~~CtE
CURRENT RE SIOENCF-STATE COUNTY LOCALITY treslOE Gn Ethers OE
«~spkea~hl .+sIDE vwEwcE ErRrs a BEDFORD
Tsa. TSb ,s~ ?TM~ T5Q.a882 RIVERVIEW
FATHER-NAME EtRSt ARDOEE EA.Sr MOTHER-MAIDEN NAME ERl$T YOOEE EAST
6 NOLO MARICOFF LUC ILLE PAIOFF
INFORMANT MAILING ADDRESS SEREEE OR R E D NO Glr OR TOWN STATE 21e
t`~i°~'ANr TBa /Sgnature/ ? TEtD BEDFORD MICHIGAN 48239
WwKM LAVE - I MenY INt•een wet en0 oesm
RASE t0 1B_ IMMEDIATE CAUSE / NE CAUSE / O s , ,
tvC,~TE PART Ilse Car CinOlila O~ COlOn 1 Y
SrArtNG rNE 3 ears
vm[RErtvG DUE TO. OR AS A CONSEQUENCE OF: I we.a se1•e... wse ..a aese+
CAI:$f EAST
- I
ID? I
~I DUE TO. OR AS A CONSEQUENCE OF I Mtenal set.<e~ wN sM Natr.
1
' EC) _ _
' PART it OTHER SIGNIFICANT GONUtTtONS-Cu•.e..r•a eo~e.Ow.+V b aealn twit not .eWea b ceute n ?ARr t AUTOPSY (SpKdy Yes t WAS CASE REFERRED TO MEDIG4l
or Abl E7(AMINER~ fSpeaty Yes or Abl
I
zo. no LIT AO
PLACE OF DEATH 11io•-v Hwy F HOSP. OR INST., awc.u [10A 2!a r'
MgpleE Aw~oW.rel /Speefly/ ~-Emsr bn. tpet..e lSpeutyl lCAtC1 ~ rt•~ cese .e..e•ea aM ee!e••.e•ee •01 to W • ..~nfu1 e..•...rrr'a csu
I2 a. hQS - 22b. • - h,t a On ene Oe» W ecs•enew•• ..ao. n.eu9+to. . ~ e.aM occ~..M n vv
23a to Me eK.t d mr aroer40,e AtNw e1 t1•e c.r Date W a*o Due to tewe oete e+a pece ew Due ro-trv Er•se(s1 statN
V•e wvW siMea - - -
I 1' r
p z /S~gnature and Titk!1 ? _ ~ ~ x ~ ¢ /Signature and Trtitl ?
2 < DATE SIGNED /MO., Day. Yc/ HOUR OF DEATH t 2 DATE SIGNED /Mo, Day, Yr/ HOUR OF DEATH
i~ Q> 23D. 12-_14-79 z3c 12:15 P. M Ise Lac. M
i pd NAME OF ATTENDING PHYSIGAN IF OTHER THAN CERTIFIER (Type orPriwtl ~r PRONOUNCED DEAD /Mo_ Day, Yr.l PRONOUNCED DEAD /Hour/
• 23d 2.d ON ?4e AT M
NAME ANO ADDRESS Of CERTIFIER ~E'Nr51CUM 011 YEOKAI EAAM.NFR1 /TyptorH/nt/ .
Is. Robert W. Brownlee, M.D. Her?rY Ford HO~p~t~~_ ~etr,~it, Mi gg2A2
ACC. s tOf HOY NATORr1E E1ATE OF INJURY lMo., Day, Yi.J HOUR OF INJURY DESCRIBE HOW INJURY OCCURRED
011 •E s'rYESr 'Sr~..'~~r•
26a ~V~ 26b _ IBc. 26d
NJURY AT WORK PLACE Df INJURY-At 1.o••,s Is•T sLM txlory. p11<e LOCATION STREET OR RED NO Orr, VNtAGE. OR iQANSvti SLATE
/Speedy Yes w lMDI su+e.y e+c lSpetdy)
?6t. ?61 I6q
~ BURIAL. CREMATION. REMOVAL. OTHER CEMETERY OR CREMATORY-NAME LOCATION OTr. VilE1Gf. OR ip•A1s5.1V STATE
lSpetrlyl
ITa BURIAL.-- 2?b. `1r49DNIERF.__--__- z/~. __DETQ~IT -MICR=6AN
I - . - - - -
DATE lAfo., DaY, Yr/ I NAME OF EAUUTY ~ADDRE55 OF FACILIi~4O1 Schaefer Rd.
~-i _ 2Td_• 12/1779 _i?~ McFarlanc~._Fos eYal__ ~ IBb ~ a~~g~2~,-
B 3 ~ fUt/ERAL SERVIE LICENSEE: REGISTRAR DA 8Y GIS RAR LAO.. ay,
lSrgnatme! /Srgnawre/ 1~' Yr./
~~BI ? ~ IBa . ' o• ~ ~ 1979
-
I HEREBY CERTIFY THAT THE FOREGOING IS A TRUE COPY OF THE RECORD'~iFIL$~I~T THE D$TROIT
DEPARTMENT OF HEALTH; ATTESTED BY THE RAISED SEAL OF THE CITY 0~' " ROIL
T ~ r
(98D MAR 19 ~ W.1 i2~ 51 ~ ~ 1~ ~
~ ~ ~ ~ T~ IUC~E~CGIAiTY f
l A. ~ •2 <s='-'r'~J
f~ ROGER POITRAS JOAN B. WALLER, • JR. , Dr. PH
BQOK • P4CE ct.ERK culcurT c~t,~T ~ PUBLIC HEALTH DIRECTOR
~ _ RfC~R/ ~'FRtFIfO_ _~~.r_ ~ DETROIT DEPARTMENT OF HEALTH
DATED VITAL STATISTICS DIVISIO.: