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e3 ~ ~ rTwrs at~Ano o? Nt/?LT11 CERTIFICATE OF DEATH
•R rw• EtY11fAY ow VITAL fTATlmq fTATt <rllt N0. ~
FL08IDA
Ir•Mrl~ al TN NO. R[OIRRAR•D NO.
?tc•••tH 1. PLACE OF DEATH Coo[ NO. L USUAI. RESIDENCE tR~.dKew+uti Ittrueww.:ee.w....t,.rn t
ua trtli couNn
il...a - . srAn Florida COUNn 3t. LuC~le''
N*• b. CIn ur .et.W. entMetO lustu..eta Ituw.) t» LENtiTH OF e. CITr pt OetNN wetret0 uau, .rw Ruluta
totie>.t OR STAYltOt•It~1aW OR
{ll•• Fort Pierce `s
e d. FYII NAME OF trt 0a t0 bwlw.r IMltette0, ttw a~en 0/tat rr InetMO! A STREET tlt taOL ttia beetles/
HOSfITAI OR AppRtltt
iNST1T{IiION
...1 LOECEASED a tri:.t) b' t1iMOa) L ATE t3laatU tDa) tYear)
t t~:.eJ DEATH -
- ' E M f~ t
wOR OR RACE t• ~
WEb
~I~tlORRC~ DATi of RIRTN t. A~
IN~YMtI Y~iaaib ' DWw >•wii sa..~
~iti
'...~al:r. fdw~YSU.A~L OCCUtAT10NlOHe tlr .t .rrt IM. KIND OF RVSINESS OR IN• 11. RIRTHfIACE ttIWO 0r teNtp wwtgl IL CITIZEN OF WHAT .
aa•a! P'a 1'11f 6« wsus utti ww Y e.unp A DtISTRY f. . ~ D~t
la•k i~t 9
•r IL FATHER'S NAME IL MOTHER'f MAIOEH NAMi
T}..rit.r John Fisher 0 earl
. IE. WAS DECEASED ERIN U. S.ARMEDFORCEit I3. SOCIAL SECU It. INFORMANT'S St6NATUR! J.NI. Yates
tTM 0i? /U s.b tlw er twe K rnfee)
AooREu
as0rai ti. CAUSE OF DEATH MEDICAL CEt>r1'IfiCATlON )M~vu r[tlrta
t r•as•t Enter eb oa0 awe 1. DISEASE OR CONDtT10N
tot til• fK Y00 for t•). lD). DIRECTLY LEADING TO DEATItet~l Ci 1) °~TM
l0 . eei-+ ud Is)
`ti•"• - H e tension essenatial Years
t tY tN •lAia does w0t •uow DU! TO
• • • 3 tL0 •0/e y dlri*I. Y.rttii artitiswrr U sq).Itw*!
OseR u Asart Jailase, rie0 M tb •tae0 gra0 t0J 0t0b
'Ei•tr•r - ..u?.+e~...te. tt,~,a !ei r„aate,;,y t..e. DUE Toe Generalized Arteriosclerosis "
tt\i¦ 7R t'.0 diee0e0, iwjeny, p
,ors erwskati.w •~iOA 11. OTHERSI6HIFIt:ANTCONDIT10Ni
~r to•t\ ar..a dtitl~ COwditiow0 osettri~e,ti,e, is fA0 d0•A lvet tqt
l0t•r• ref0td b tAe liaeu0 er e»wditiew d0ar?.
ttiteR e~•T Ha. DATE OF O nRAI+- Nb. MAJOR FINDtN6i OF O?ERATION 70. AUTOKit
•oi-
lrr.ea~bl te0aelrr) 21b. ?IACE OF INJURY twt..fserOM,t 21t (CITTORTOWN tCOUNn)
21.. •epotMT t+w, ter. taet.q, rteeet, oleo tYt_. etal N weal, wb )<IItt~L?
0ueceot .
21d. TIOMF tY.ett.t IDar) lttrrl 1H~1 2b. INJURr OCCURRED j
INJURr a rent at tlOTt~Olet
- roar ? at*o•t ?
~
2t. I kereby txrtiJy that t attended tke detested /sotn NoV. , 1l~, toADr. 27- 19~ that t /act tov tAs deeettted
~ s~ i~• alive oe 1 and tkat dratA occurred at to rote the eauta and on Ike date stated abort.
270. SIGNATURE (DtRr00 0e title) 27b. ADDRESS lie. DATESICNED
a}l0t• •
esr.t.. J D Q 0
21a. R U R 1 A L , t:REMA- 2eb. DATE 21c. NAME OF CEMETERY OR CREMATORY LOCATION (Cer. fo~•, tK noasd) (tltat0)
noNB orAL tt..elal A H M G
DATE REC'0 SY LOCAL RE6ISTR~4'S 6NATURE 2S. WNERAL DIRECTOR'S S16NATYRE ADDRESS
•••e 1}-29-55 I'K• Anna ~ee Denison, d . r. Joseph W. Yates, Ft. Pierce ;
o.rtrh? n71E a ba r tn,..ne o~net oopq a nl. t~ot:a. . _ 4~it~9 -
registrars noord on flla in Nt. 3f. clods county Elaahh [lap.rll~ . 19$0 APR -8 PR I~ 23 •
- ~rlailf at Fort Piarua, Florida. -
.
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(1NarrJin~: Not valid lJr?lass ratted saal of tha ft. Luolo • ' ~ t?ilEO ANC trCOMtO '
ST.~UCIE CWZITY.FIA.
btpa?tn>aM~ ~ R GER PWT1tAS ~
~ ti 61.ERK CNtCWT >PitNtt
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t` R~~IR VERifIlFO~
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off- Q ..y, ' ` ~ 1
n Oavuhr Loaf Re>'el•+.+ir' _ - .y; a' x
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2,981 t
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j 61.M3KJGO PAGE. -
O` L.AUGHLIN AND O LAUGH<.IN. ATTORNEYS AT LJ?W. FORT PIERCE, FLORIDA