HomeMy WebLinkAbout1014 488412 N
• CERTIFICATE OF DEA ~'H
I)epO?Eward d IkaIIL aaad Ra•II.I.illlalire `errke. liTAT[ 'IL[ NO.
TA~NKL~uEIR.uTTI FLORIDA
irr(. OR ?RINi IN taat•tw•era.q.1r1e1 R[GIRTRAR'• NO.
?ERMANENT INK pECEASEO-NAME 'uf• r~OMf a•fr SEl DATE OE OEA1N ~rOwtw, O•t, •f•aI
SEE r?~OIOOI TDE
a:TEY(TIORS WILLIAM C. RICHARDSON ,Male ,December 2, 1976
RACE enwte• wf6aJ. •.uncw Iwouw, AGE-asst YwOfa ~ n•t YwOff r t+.e CATS d RNTH rrowwr, u•, COUNTr d DEATH'
fK. , aNtr~Fli to w.r.».. ~,f..ll roa a.. woYfa r... te.t r
• _ 52 t. !March 11 1924 ,.Marti n
CITY, TOWN, OR IOCATWN d OEAM wsnf Cr• ?wwf MOS?ITAI OR OTHER NSTR ION-N w woe rw Hrwta, Grs feglr w wYraff r
s•ecr• •a a wo
Stuart ,e no « 2983 S.E.Camino Avenue
STATE d MRTH ~ r wot rw r s w•rf gniEN d WHAT COUNTRY HARMED, NEVER HARMED, SURV1rRJG SNOUSE r I• .Irf, ant aa.oew w•rf r
towtn r WIOOMIEO, O I tsftrr f
~a~...fanfrcf . Tennessee_ U.S.A. N mdrr~e~"E II Patricia E. Cone
Brae wu•sfo
~•.IO w sf.n. SOCIAI SECUMTr NUMRER USUAI OCCU?ATK~N aewn ara0 or arpfa eowf oYtrwt. wort a KMp Or RUSMdtSS OR MiOUSTRt
OCCUtatO W erOtarw lYf, f•!w r qMN 1
:;~o;.;t
N t: 410-26-3347 IT. Pro rietor I>? Norich Marble C an
.o.naww. RESIDENCE-SEATS COUNTY CRY, TOWN. OR IOCAi1pN rsrtf Inn aarlq STMfET AND
r arecr* ns at wo
If. F1 on da I«. Mar i•n I« Stuart Iw. no Iw 2983 S. E . Camino Avenue
rATHER-NAME aqt rwapf ust MOTHER-MAIDEN NAME rrfy rr„q uyt
II William F1 tc H. Kenna - C ton
1lM~ORMAA,iT-NAME MAItNG ADDRESS asrgtr a a.r.0. rap, cm taa Barr, at•q, Ira
ITa Ste hen Richardson IR+ 2973 S.E.Camino Avenue Stuart Florida 33494
?wRT OEAli1 wAS CAUSED Rr: - ! IENEER ONIr ONE CAUSE /ER lRE FOR pS AIID affref•r ow~aat AarY N
N, w.rw tAIIM
h3 ~as0
cowarirOws, rr •rer,
arwlCw o•r! taN p A~ /
S ~ /
rrraM•ta t•Yaa eel, M q, O a . cOMafOYlKf Or:
al•rrw0 rwf YwaaF
a•rM6 C•Ya! a.at
?ART ¦ OTHER SIG?IIEK:ANT CONDITIONS: cowawows co.rfwsn..w rO Hf•wr wt rrOr qurN ro c•Yq cMw w ?•n r w AUT01Sr O rEi r.fta rrwrrratis c
Ins of r•Or YNaN rra Nagtr.rrwp f:W
M NO A da•iw
V~.r.•Y~eMy.~1 AWOEI~.-StMaDE A a rp.rw, u•, •eu a HOl1R HOW INJUtr OCCURRED e.mt w•tYq or swwrn w r.n a o. tear w,
I~I~Dw.M~-,K/~•J,a•DE: OR IMIDETElalIWEO I ow raf
?w 7R< M. IRi
INJURY AT WCaMC HI?CE d NIURr •t worf, rear, sraeft, r•aoa•, IOCAOOH I angr of f.r.Y. wo., on a ro~r•r, uee r
I arfC~•• of w w01 OrrKf taaw.,fK. esncr.l
RIa. TRI T•.
CERTIEKJaTKFi- rOwrw u• n•a rowwr o•a •w uo ufr yr wr/wet ur.a fM ran/orY wpt rrfar w OawM OtCYnaEO •t rwf rup, Ore M
rH.SKIAN: TO rprM M7 nY f00• •rfft N•A. IwOYaa M4, •w0, q rrr of
a •mwuo rwe
71t otc[•sfo rtor TJ _ ~y 21E - llc ~ ~ ~ TIR , O : 40 a or r• oapwaEYU,
_ _ / Z- - 7 D 1 D :I, ro .r C•rrgr>,a s
CERTYKATION-MEOKAI EkA.NNER OR CORONER ow rw uses w ar wo,ra or a.w, rwf eeclOfwa ~.s rtowaw.clO Ou0
fa•r?r•hpw M Mf t00• •w0/Of twt unfsrrG••Ipw, W r• pawa.Ow, rowM Y•• n•a wort
K•ew OCCWaN Ow rwf wte •raO Oaw ••D rwf Uarif~rl Sr•n0
~ 7Jt. _ M 1!t
~ CERTIflft-NAME mN of rfwn SIGN T efaaef of mat ATE SIGNED rrowtw, a*, •f»f
_ Lester Archer, M.D. M.D. Dec. 2, 1976
' MAKRiG ADDRESS-CERTUQI srgfs Ot t r_o crrr Ot ao.~w
j 417 Balboa Stuart Florida 33d~4
~ tURUaI, CREMATKN•a, REMOvwt CEMETERr OR CREMATORY-NAME IOCAIION arr M to.rw st.n
~ ,`Burial _ Fernhill Cemetery Stuart Florida
~ DATE ~..owrw, o••, n•ta EUNERAI HOME-NAME ANO ADDRESS ~ sraea o. f.r.o wo . crt• a rorr.r, serf, ,n r
t° T« December 4. 1976 :s. A cock Funeral Home 505 0. F d. Hw . , Stuart, Florida 33494
S. R£ 12 fUNERAI O OR SIGNATURE REGISTt SIGNATURE Ow1E gClrrtO a• rotwa atEW3raAa
h e 19 7 G TT! rw • Tw / • 3 -
's
~ Thereby certify this to be a true and correct
''~a~ copy of the Local Registrar's record on file in
I _ = the Martin County Health Department in Stuart,
I r , ' • S'jl Florida a
~ ~ ~ : ~ (Warning. Not valid unless raised seal of the
- ,a.,,_ gin- = Martin County Health Department is affixed.)
d ~
~ .F~ , .,~r'ai
~r:~ ~ Archie McCallaster, M.Or
County Health Officer b Local Registrar
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