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James D. Camp, Jr. , Esq. 19$0 NAY 22 PM l2~ 33
P. O. Box 14636
Fort Lauderdale, Florida 33302 ~~~EO~~,ii~ffku~
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r 7 4 2 ~3 Q ~ 2 CERTIFICATE OF DEATH 1
DaRweRolwt e1 ~~ew11~ wwa lr Ilrthe Setrleee fTATEt RILL NO.
E>tvs1~I aF II~wI.r+ FLORIDA
TYFE, OR MINE IN •w•s•aes""sef'r'° R[GIRITRAR'~ NO.
- MRMA/RINT INR; T-NAME rlesr raleele usr SEX OATS OF OEATM r rowrw, O•r, .e•!r
SEE RAYi00E FO!
~ Elmer J. Lehnhoff ,.Male ,November 27, 1974
RACE wmE. wow. •.ee/uw I//eY\I/, AGE-usr lelea r ?ua woe! r e•r rOrA.e~1~ OF pITpM Loyal. eA., COUNTII OF OEAM ~
eK- 1 sreere 1 wtlyy.I,l.aal A.wt~ w.t lawe •w. Tu ~ 1 V 9 T! ~
e. White (7 Broward
. OHM, OR L TMDN 1H r+sN em slrl.s MOSFiTAE OR OTHER WS - rr sspr w arwe, asre saes •ISO Irllrsea+
~ 6 G srecrr ne a sw C.7
,Fort Lauderdale h. Yes >a. M ~r;
t STATE OF RM1M Ir slot w Y. s.•., 11•ri CITIZEN OF WHAT CO1J/eTRY MARRIED. NEVER MARRIED, SIIRVIVReC 3F'OUSE Ir v+re, ollre r•loer IYYe 1
Y~eeelee~ R. Ohio II.S.A. ~
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r'~e°e~"'"' Rose Blaes ea
rwaae otu•eee SECURITY NUMBER USUAL OCCINATIGN rGne two or rrpat ellw e11eY/0 roar p RTO OT RUSRNESS OR MJDIISTRY
occweae r
eat waeaoro sloe, ereH r /.•aeo ? ~p
0e~~e 289-10-51213 I+.Sv erintenaant retired Is. Rueffer Rubber Star~u C~-
~ RESgENCE-STATE COUNTY CITY. TOWN. OR LOCATION olslee cm s•.es STREET AND .
Ile Florida Broward ,fit. Lauderdale 1';"~'es 1ei1200 S.W. 28 Street
FATHER-NAME rlpr rreell usr MOTHER-MAIDEN NAME elaat rleere uW,-~
John Lehnhoff i~iart~aret Polkitm~
INFORMANT-NAME MARIIC ADDRESS rsmer a e.re. /ID., Clrr a rovsl, sr.re, erl
Rose Lehnhoff IR?1200 S jl 28 St. •Ft. Lauderdale >I orida
?ART 1. OEAM WAS CAUSED RY: ~BdTER ONI? ONE UUSE FfR IeNE TOR Eo), (Al ANO (eN aaruiiul o ur w.
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~ Co estive heart failure 2 da s
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eoslelnoln, n ue?, _
wwlce o•re nee w Arterioslcoer tic cardiovascular d sease ears
Irrew•re CAYSa Ws, ells r0 CO/sefo,R1/CE M:
er•TIMO rMe YreH-
.LIMO C•Yfe l•ar
k~Diabetes Mellitus ears
R. OTHER SeGNIf ~ e~ noes torrerYrl«e ro ca.rr svr .wr ae n ro uuu Iw • al AUTOrSY IE YES weee nl.olssos
tus 03~a ~m Dal r3f SID rP se c~~on. ~"~a~'u3 p0$t "e' a "O/ a
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w e s A o 1».
ACCFDEe+E. A 1 rOrrw, Mr, r[u 1 IIOW INJURY OCCURIEO r aurae w•rYee or /IUYfI /r rut 1 Oe rue a, stet u /
LID OR iTDEtEWM1ED
7M- Tlc M. IY.
INJURY AT WORK FIwCE OF WJURY Ar core. s•ry, srrar, r•eeoee, LOCATION 1 sneer oe a.r.e. sq., erer or ro•Iw, sr•a 1
leetprr ne oa ss0r OwIG euf6.,lK. Isr[CMrI
RIs. RIi Th~
IMt3K4s1: slCrlrll o•r re•! rAr/M o?r rW •slo ulsr L.r sur/I/H •Ilre OI/ ~ 1 Ole/Ole Iwr vler rwa OEATI OCCURlEO •t rlla race. OK 'lle
rosnll wr nu Boer •rrte oewm. / o•a. wo, ro K east
~ 1 •r1lr/0!o rile • Or r. [.+Dr;!pRa,
_ eeasee .eor 3 23 ?4' Tlin 11- 27- ?4 Tel. 11-2?-74 did Tlr • 55~M ro o.a oases. sr..es.
rl/a or_eoe..r .•s rao.souucao ouo
CERTRFICATe4N-MEDKAI EXAMWER O! CORONEt: Or 111E a•sls W rlr .woe ar Oa•p
ea•rel•rww or ale Boor •so/a rllt r.rurlwrwr, Iw r7 ore«a+. rowel a•. rue IwY.
ee•ru oeaeao ol. or oyn •wo ova ro rlr u.lse/sl sr•ree.
. ~a M. TT. M.
CERTIfeiR-NAME Ilrre M ra1Mn A , • e+eeaee Oe rlne A SIG`If • IYO••1M. J•-. seal
~ TTe. ANDJZES MA.RTORELL M.De I~ Z 11-~9-74
I Mom„
eG - •MER sreeer oa s.. o. s.o. cm a ranl ~ s+.a r~•
W 24. o a derdale Fla ?
WRIAI/C~tEAe/?TION, REMOVAL RY OR CREMATORY-NAME LOCATION an p •Drr. suss
lfrtd 1
Burial :NLauderdale Mem. Garde T« Fort Lauderdale Florida
'eA~ v IO ~ 1 1 ~BlackburnAr~.E.~61~aes.E. St.;F't.e~Iaud9rdale,^la.
f• t~12 C:4E. A . Re:GISTRAR- ATLRf + Ow+E EIVED ?~Ut eEGK'atl -
Rev. 1970 ~ ? tM /~T~C./ ~ ' r '3 '-aj.[.~ tw ~~'.iZ'Yr, ~
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CERTIFIED COPY
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I hereby certify the above to be a true and correct copy of the Local R1
n?
..,;_Reg~s~rar's record on file in the Broward County Health Department at `-7
~..~YI
~r s...ar~,~u~derdale, Florida. -
6.1 ~ gtr~No: valid unless raised seal of the Broaard County Health ~
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~2. kD~partment isfixed.) m
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' 't~r.~•;" '~"~a~ '.;,;1~ti~~;,~='`~~~3~ Coon wealth Office and Local Registrar
Deputy Local egistrar b
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