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CERTIFICATE OF DEATH Et.,E n/e No.~._ _
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.ItYANENT T. FRANK JAMES ' SIM - ~ Male QPt.2, ~ 979
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Ft Lauderdale Hol Cross Hospital Id-Ini2atian~
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Florida IK. Broward Id..Tamarac 141 11$19 Nj,T 8 Street IA• es
EA EIFEt-aU1EfE i1tSl MrDDEE WI ~ MOTNFt-MAIDEN NAME hKi MEDDLE IASf
IS. Frank James Sim Ma L
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I s F~milia. Sim T>b. 481 NW 8th Street Tamara F
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DAfE SIGNED /4...•r, T•.! Nplf Ot OEAIM ~ DAtE SEVNED I4e., 0.., r..1 tIDEN OE OEAM
se t . 4 ,1979 _ ~ 3: t 2 r- 4 ~ ~ n. M
NAME OE ATTENDING MIrSIC1AN lE ODEt tiWl CflTINEt, rr,e w,.w) s ~ rtONDUNCED DEAD IMe.. 0.r. r•.) rtONO1NCFD DEAD /swl
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- NAME AJQ AOOtEg OF Cf ttltlfl D'II+rSKUw, MfD1G11 EEAMNeEq /rTN r,ry,r.l
n Robert S. Mei s MD 2 SE 1 th St, Pom ano Eeach Florida' O
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OUE TO, OR AS A CA/6EpUEHCE OE. 'tw,rnd • e,.d deed, .
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t rAti OTNEt SIf~4tl(/UA C/X~ll,oeg.{,e,.ew.ery ce.~w.t,.r,.y ti deo•, !w/ •W Mewd ro cOVet t•`••^ .n Mtf F MI ?UtOKr /Sr«./. WAS IaSE REt ttf0 t0 MED!CAl
it V ~ NO,r.r rl »AMINER /S~~awx.1 ~
N•~.••~rl ACCIDENT, SUK~DE DATE OirN/Utr 14... M, rr./ MQrJt OE IN1Uty DFSCEitf NOW INjUtr OCCUttEO e'
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e, i yII IN)UtT At repo[ /Sre.Je fn ?IAQ Ot NEAp'f-J1r ro..e, 1rw., a+ee,, IecM,..,1.ce Er.W.p. IOCAifON SItFEf Ot R.F D. rte. Utr Ot TOWN STATE ~I ~ .
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RECORO~D ,k THE Ofi1C1RC sECOitbs~odc
O< BRaWARO COUNTY, FLORIDA
GRAHAM W. WRTT
CERTIFIED COPY cou:+tY ADMINISTRAT08
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I-tiereby e~rtify~.the above to be a true and correct copy of the Local Registrar's ~ •
record on file in the~Broward County Health Department at Fort Lauderdale, Florida. G~
(Warwi•ng-Not 'Valid unless raised seal of the Broward County Health Dept. is affixed.
4 X35408 ~~a~~ FFFFFFFFFFFF~~~~~~~
• • - {960 MAY -5 P~, 2 38
€ Coun Health~Of icer and Local Registrar
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9-6-79 ~tDGER PWTRAS ~~//~1 'v ,
p.ERKGRCUIT~ Chief D puty Local Regis ar
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