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.o m S ~ I~IpENCE - T7E ooullTr oR sTREET A!O NLIaaBER oR RfD NO-
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N = ~ m FATNER$ TimOt~ Ft~2^nr- ~ 1aoT11EI1'S M~EliBabeth Hartnett
g ~ - ~ ~ ,soRlw+rs NA#iE ANO ADOR6SS REUTION TO DECEASED
o 3.l. Mr. John J. Irwin, 991 S$ Maltera Terrace, Port St. Lucie, Fl ~da Husband.
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QS W OEATN.000 TIC DECEDBtT WAS PRONDUIeCED DEAD DATE SiCrNED rrorrM w•..e.w
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t = C - SOT DATE NAME OF (~eEIERr OR CREIaATORY TIpN a*- rora s counn a*.m
J 3 ~ ~ ~ March 22,1 Lauderdale Hemorial P , Ft. Lau+derdale,Florida
U O C 4 i ` 4K' • 2. - 2~c 21d .
o v 'v a< O , 31i3~.:uRe of Fu1+ERAL owECTaI ucENSE No.
W ~ ~.z ' ~ emesial Home, Ho ~lo da
a~ 13yrI?ood, ~ Irving P. Panciera #10l~1a
' , t ;REG. SrGreAtuRE OE ~ TURE OF EMBM„I~A s ew.rca LICENSE No.
G+~S F(WIA 21b1'S~ e : V t~=~~ j ~ T/~s~
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I do,hereby certify that this is a true copy of the death
record on file in this office for the individual named hereon
MAK ~ 7 1980 e-Y~~•~Q~2~=~N u~
Date Issued Deputy Register of cods nd
Registrar of Vital Statistics
Durham County Health Department
Durham, North Carolina
48'72'79
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