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CERTIFICATE OF DEATH [T.T..IL[ rD. _ i
Ogahlad M IUdIb M M.YM.[Iw lades
wnt..TAnaxt FLORIDA LOCAL nu ra.
1
o[c[o[r[-.reAre rta[T rlDae LAST sEx wtt w aAM / r. , N+,, t..) `
o. rtINT 1
ntr[ur[rT T. JACK DE BELLIS _ r i~tale ~'eb.3. 1979
tLIIC[ aaE tAtl--..0 . 1rl\I.a~ ADE-.tee ?Air UNDEI 1 nu 1?1pE! E OAY DAf! 01 a[M /r... Oq. t•.) COUNTY Or DEAM
Aa IA~IIw, .t t ! OA Nou~S~i
- Khite s.. O ' ' ~Feb.11 1 08 Broward
cm, To[fN a LouTwN or DEAN NotnuL of otLre I.onTVnoN-.h,,.. n) .....:w......I...r ..r ...l..I Ir Nos?. of I.sT u..s.« ow.
~rauderdale Lakes .Florida Medical Center
Suit Or tltM /U wre fe CI11[EN Oi WINI COWTfY rwetlEO, NMt rwIt/ED, SYtVMNG SNO{6E IU .Jr. rerr rMw w.)
VsJ, rr rwArr) I[IIDOW[D.pVOlCED /tpei)r)
U6EMl tELDENCE -.Rhode Is. U.S.A. Ta Married TI. Bett Tro
11VE0 If OEAM tOgwl fEMIfY NUWlt Ib1Nl OCDUrAT1pN rto. [i1 wt Iuer dv.y cap Oi tNSINfSS Of apytttY
a6I1TUl WrE it.
r[SIOENCE rOl[
~ 182-0 - 01 t>r. Waiter Ca tain Restaurant
IELDENC[.-itATE COIRI[1I CITII, TOMM Ot LOCATION It[El ANp NIWRt INyOE CITtI UWK
1 c„r./• rre r.
ty Florida IA BroWard 14. Tamarac Iy 00 N.lr 1 Av 1~•
iA11rtt-riAr[ RtST rr1001E LAST IIIE!-WIDEN a1ALl[ rltST YIOOI[ LAST
t:. An elo DeBellis t.. Antonietta Unavailable
a'arOtrlANT-r,Ar[ rt,,. r I•ir) t/rl¢ ADDtfB Sit[EI a t.r D No. Gtr of toWN STATE [r
TTr~ Bett DeBeliis t>ti, 5009 N.W. rj1 Avenue Tamarac Florida
h,tUt, CRErAigN, ttMOYAI, OTif[!(Lpeya/ CEYETEl11 Ot Ct[W1TOtY~EArE LOCATION CITY OR IOYIIN STATE
I~~ B Tt?Queen of Heaven t•~North Lauderd 1
r11o,EtAl IINi[tAl IIDrE
~ tE.A)ennin s 3904 W. Commercial Blvd. Tamarac Fl
1. Md .f ~ « wot «d tf.. O.• tw.•r .t rrs+ro.rw Md: r s..w
Z d 6~r ti ar •.~W. ~ .CCV..N M M r...... der. a.d M.c. Md AM ti IIr CwMW MrA.
wn t~cNED /r., b, r.J ItOlr DEAN s d?tE sICNED /r.., D.,. teDtlr Or DtwM
>o?. Feb. 19 9 ~ t 10 A.M. r 3 rl? tIC r
f ~ NAME Oi Ai/ENDMaD IM[KIAN t[ OMEf TLIAN CftTINEt rt»..r pw) = Y frO,AUNCED DEAD / r.., ra.i. I•J ntONOUNCEO DI•D /Nw•I
~
~ 70d ttd. ON 7N AT r
' NAitE AND ADOfES3 Or CE[TIrRf pNTSIClAN. AtEOKJ1l [xArMEfI I M1N rr rwI
N z: John Stepanian~M.D. 2 31 N. State Road Lauderhill F
¦t41SttAt OwtE tECE1vED tY [EGKTtAt /r.. Oq, t•.1
coNa,loNS /sv..•..., ~ ~~~0~ <~~!/f.CG~'.C'6!~ _ »Feb .~S -
ti wN7 . /r I. ~ Iw4r•el M'ww uwre• sd dri
yyNl~ WNF UwwEWwtf CAUSE ILIt[/ O.T[1 ONL CIOS[ lfi GT[ !OL 111. 1 1
F.SE •O
IrMfOeAtE rAtT bl ~ • ~ ~ ~ iw i 1 i ~
CAUSE bl 1 r G ~~(~~-C!'
[testes(; rNE
ys ~ ~ILY~; OU[ TO, p AS A COidEOUENCE OR 'twr«rel 6a.•.e~+ rrua wd deA.
i art %,nI?AS A at[ as ~ 4.«r.l 1r•...w w da.a•
C ~
• - kT ~ -
~ rAtf OTirt SJf,N1fKA?/t CONp rww~ er drad~ 6u• wN nleud ti re..r rww w rArT 1 SH AUtOKY /Sr••h WAS CASE rfi[[rE0 t0 MEDICAL
~ EE n , No) »wrlNEr /_srO , t«..li./
t?*eloWrl AcuOINT. SUKWE r DAEE Oi aiJ{Itr /r.~ An: r•./ N01A Of INxJK DfSCnu IOw ~.lMr OCCtINED j1Vf -
E NorKmE:.. uNDEt[[rl?rtD /sr•.•nl
I ta. ]!b. zx r ne
' IlaS ier-. 517, TNAIt'/ AE Wp[ /Sa«•h 1.. rlACr Or INAxtYJU Irn.r. /.ww, e••.M, fera.a, rAty 6.nlbp, IOCAtlOf/ STtf[t Or f r.D q. OTI Of 10~M1 STATE
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- - CERTi FI I:1~ CUP1
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I hereby certify tl~e: above ~tb be a true and correct copy of the Local Fegistrar's
Flariua.
record on file in_the~Broward~County health Department at Fort Lauderdale. j
- ~ r-.- nt~• It filth ~i•~rt. is affixed.)
~ (Warning-Not valid~un~~s raised seal of the Br~~•arll ~~~i~yc-~J
~
2-6-79 -
" . ('f.~nlty ttcal t~T Ot fi cer and Local Registrar
Chief eputy Local Itegi{ltrar
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~ 4~502~
19E0 APPL 30 P~ ~ 40
F~cEC =hc p~coEwto
K S
(ROGER
PO
TRASH
CLERK CInCUIT CQU
i r(COf~ vE"'F:f'!. ILK ~~cc~~
600Xer.~~JU Pl.GE~~~
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