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4l~`ZS39 CERTIFICATE OF DEATH "A"'"' "a-
OgwE~•Y d IMYq W WENIM.Mw fwrlEEa
wru a+Ananc• L O-R i ~ - - EouE raE 110. 228 .
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E~ re/NT :KCtOEnt-_NArE HEST WOD?E EAST EEx GATE Or OEwtN Ir.., wn, r.•/
r.rE"rErr T. ALBERT GIBERSON :Male x A r. 3 1980
EEK[ IN[ lACt-+E : wer. EWE. AgE-Iw• KIra6A aoea T Y[Aa IIIDEa 1 wr DATE Of EIEM /r., Ellr, r•J COYNTII Or 0lATN
A/? Iwd~w..t 1 /s,..J,I /rn./ ALOE. OArt NDIIEE EIIrES.
6602. White 55 1 k .-Oct. 19 1924- ><St. Lucie
can. Toam oa EouTgN or ouTN NOErITAE Oa oTIEe rsnmlon-wr /p.a +.r.. i.. w~.«.r...E.y n noy. oa rsT. lw~.. Dow. .
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Fort Pierce >t Lawnwood Medical Center r
STATE p ME1N /I/ r i• CITIZEN OE wlMi COYNTtr EIAlaTEp. NEVEa /EAal1~, S1MVIrINfi sI011EE /q w/r jM rifer w•/
f!.S.I.. r.• .wwr/ MIIOOMrtD.OIVOE[® Isl•silil
u1wEEOIDEN« • New Jerse U.S.A. lo. Married T1~ 1 Maser
rnEEE OEClASED IETIMI OC[4EATION /Gw W M wrE Ir•~wy [EO Oi EEaWEEE OE MOiKiRr
«QD~~It ~ATN 19CU1 S!Cl1tIlY W WEa ~ ~ wrw W. w.. i/ hYN//
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aEyotNCE-~tTATE C0{MTr aTr. Toww of EoCATION mEr Aw NIwEEe /
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I••Florida St. Lucie Ik Fort Pierce IK 4122 Ol a
/ATIEE-.NAPE ilaST IEIDDIE EAST TIEa~1A1DH1 NAPE HEST WODLE {AST
Is~Albert Giberson Sr.. T• Eliz
IWWAUNT_,.ArE Irir. EsND AOOEEEE STEEET Ot a i.0. NO. OT/ Oa TOwN STATE ZI?
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. Eua1AE, nEYAt1ON. EErOVA4 onEa /s,.~/,/ CEYETEar a QEYATpY-NAME EOCJEt101: an Ot TOIIM STATE
a I•.Cremati on T•Cal 1 awa Cremato !Balm B
~~alpa.-/~....L. • 3015 Okeechobee Road
170 NAISLEY-H BB F
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. r.. IIDIIE TN DATE sicl+lo /r., Elr,. nJ IIDIR Or DEATH
A ri 1 7 1 M ~'s
N11ME Or wtrEIOING ?/nSICUW Ir onlEa TIM/i CElnNn n,r• r r..l s ~ ?aONOI1N[ED DEAD /r... a... r.J raO•KAlKED DEAD /r«.l
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NAME AhQ ADOEESS Or ClanNEE Ir1ITSICUW. MEptwi E>tAMINEq /r,,.. r+4
C ~ Wi 11 i am A. Stol zer M. D. '
atcntw • DATE EECEIVED EY EEGESttAa /r... a,. r.J
CCIOITq/a ~ V 1
WHIOI W VE Iw1f0uTE G{RE IC•T[t OaLr Os[ CICiZ I lOA /.A /11. /1,• /s1.1 ~ Iwrrl EMwr d rwl
tuY'FDIOATE ?AET W I
I CAIRE W Cardi o Respi r~tory Arrest ~ , 15 M0.
sTAT11R' TIE
U•OlaEr~ DUE TO. Oa AS A CONSEOIIENCE Of: (IMYVd Ewwiwl •nd rl?
CAIbE LAST
Metastatic Carcinoma From Lung ~ 15 Mo.
---.ODE TO. Oa AS A C0,6EGUENCE Or: ~ ' W,INI Ewww «rI wd ~ra~
W
E/~ET OTIEa SlG/ell(/1NT C~pdTlO,~--Cr.d.aw wr~E~lry N Ae~ M wr wy~/ r owr D,.M r r.UT 1 W AYTORR /sue/, YIAS CASE tFRaEfD 10 MEDKAI
N ,p M r) EIIAMINEa ISMs./, l- r A~/
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I?r••s4d1 KCtOFM, EI/KIM r DATE Or INIIIEr /r•_ EL,. T•-1 IIDUa Of INAEr 0lSUNE NOIM MART OOOIMEO
IIprKWt, r Ef,/0E1EErwEO /s,.•J,l
/+K r.~+ sl r. Owar AT wOa[ /s,...h r.. ?IACE OF 1NJ(IaT-w/ Iw-, pMl, 4clrr. •ILn wnld.q. LOCATION S"EET p lr.0_ W. CITY O! f0'YMf STATE
~zr a. nr. ~
4 X2539
~ 196Q APR I 0 AN ~ 1= 08
t nenby oerttfy this to be a trw. end aanN copy of t'M Locat ~ IEU~C~ C~u1t~:flA.
T 2e~istrsr's record on file in the St. Lucie County Health OepeA• I-. ~ CM~:~ C~
~ ment at fort Piece, fbrlds. -
` ~ VERtitE~
(Weraing: Not valid unless wised seal of the St. Lucie
County Yealth Department is affixed)
N. D. MILLER, M. D.
i'
' Coun Ith Officer 6 Loa! epbtrer
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Local Regfstra?
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I?R 449•
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