HomeMy WebLinkAbout0358 ~~t''1943
This instrume~rt was prepared by
R~ ; ESTATE nF Chester B. Griffin,124-A No. 2nd St
T~o!~AS t~ . co~i; , sR , Fort Pierce, fla.
DFCE?~SEn ,
Lots 10 and 11, Alock 18, A. C. DITTT~lAR'S SUBDIVISION,
according to the Plat thereof as recorded in Plat
Book 1, Paae 27, Public records of St. Lucie County,
Florida.
_ - - _ -,.~._.._r. _ _ - - - ~ _
tat. Bo.ra ~ He.~ti CERTIFICATE OF DEATI•I state rte xo.
Ij Korean of Vital Statietica FL~tIDA Rel~i:strar's No:
is---
I~ 1. PLACE O1r iD~EA~TH~•~ ~ ~ / USUAL t1ESIDt3~ICE OF DECEASID: _
(t) Coaatr _1' ~ ~•1 _ _ DI•trkt No. ~..,r '(1) (,oaab- J'i~L~!-'t~i,~.
(6t i'reein•t 1'e•eiatt No. la1 Stab ~ "
aaso. • ) -
ii (e) CiVor - - Cit/ot (e) l1Ml~ ar two
1b•/n 'Ibera N ~oaYNe dt~ or bia U
1C1 Nantr of horpibl or stieltwtt ~~t
(It vat la iaapltal tr htNtatioa„ vrtb aaetMt or tlw) (a) Street Na
te) l.eaatA of dyr: In or (Unrd.alrt floe) w
r i n ti:ia eoalmu4itr _ / Y_ - - - " ~ ~ !
swra. twoatss K aa>ra) N pia Sore. io+ leas M iI. s. f ~ / 7•ar' ~
it
r
~ 9. FULL NAVE OF D)pOiA~ ~ w 1 ~ ~L 1 _ _
r s la) It referee. t A) ~6te1t11feaarMl IIEDiCAL CE)tlIRCATIOI!!
aame~ar _~.1-~'~'t't- llw Dab YoaW ~ _Da>r ~.T_
~1. Sn t. OoMr or rtes Year Soar ~i1 1lMM ~ ~
!1. I nerds eS~y tint t at~
dcd tse a•eewd ltexa ~
6. BMek, a+trrka, oiiwd a al..e.ta I, O~7b -~+t.~ IP ~t
.I 6 (t) It samba. or et (tr) ~ ~ _
tsar 1 last w. s ~ o1M a
~I wib of Y~ • tea flat dwts oeeevraa au tse ante tad soar stabea tso.e. Daratiea 4
'I J ^
E (Ts) Ale of hsMa~ er It tN•o (>Q f >~a aatt et acorn
Birth date of aee~eYea _
(ettati) lav) (Iletr) _
i i i. A>; Yeaes ri~t]oVt Dq'''a) it !w tlaw •r 4v Do?o b ~ ,
~i? ~ / ~ / see. sis. Dee to ~ .
_ _
9. Ifirtbplaee ' ~ ~ ~
I` (Gift. t•wa w a•aats) (8 or toreiso ewatry) , ptser eonditloas Itld• presuser witsta t raoat~ o[ {eats),
h 10. Ueaal ocropalioa
Ya}s Aaatatta: Q
11 Inda.trt or Irualnes r? -
i ~ . ' of •p•rsti0ot
~ a 12. Name - ~ ~`-`'~V ~ qaM h
t~ ' ~
• (Giq dab of operation) woks Mats
laioal~ Se
6. 1!. Nirtkplatr ! dareea Ma-
~I - ~ K tYbpat _
1 ti,tlralb.
z lt. Maiden mate _ , tr -
~ ~ X I 1S. Birtl,plrtee
- r - - Z2. I[ daati wa• a.. eo •:brad Hater, All la ts. tollowlaft
16. Inforraaatl 3f[aatttn ~ (t) Aoeideat. wisiao. sosietde (eped[>/)
! ! 1s l.? wddres `•~-f ~ ~ l • ! ~ Io) Dtte a[ aeevrmee ;
_ / iel ~ISere aid IaJttrs oeeart
il. Burial, ereaution or reswortlt i~~-~u.~~t' (Clyortowr•) (Coaatf) (Stab)
~ lal Did la}art Decor i. or about cost, a farm, In ladlrtrid N.ee. h
lA. Fonrral Dlreetar~e - pantie pkteot
(eptettt ttM ~ picot)
18 (a) Addres t?sik at work t _ (a) 1leate nt Iw}ors
19. Filed if t3. Sfisatoa - IL D.
i ~ L•w1 Iksletrtr lal Aadres - t)tte Sisa•d t 9 ~
€ I hereby certify this to be a true and correct
• copy of the Local Registrar's record on file in
~ the Martin County Health Department in Stuart,
. Florida.
~ .
r (Warning: Not valid unless raised seal of the ~~94i~
~ Martin County Health Department is affixed.)
% Archie McCollister, M.D. ~ Zg .2-
- - Count Health Officer & Local Re istrar
> 0.EkiS Cii:CL(11 L6L.~
t - ~ 1.
~ ate Deputy oca Registrar
a
r 8(?i1K 332 YeGE 35g
3 ?.ARTCgE:-
i P O 90x (270 rORt PIERCE ~lOR10A 7D450-TEEEPHOHE~305.464"9200
~o
_ uK - _ -
g~_