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stage of F1oEiaa CERTIFICATE OF D~ .,.i
Depaiteal~t Oi Heald atd IZlbabllt? ~ ~e 6e=r1Cee RAT[ FIL[ NO.
, vrrwz. srwTlsrlcs FLORID 1~ ~ .
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IN , IELAI~ID A. 1I•IOIWPON ,Male , November 11, 1977
?f RMJINENT eACE rw. r•ro...aaar wG[-uar wra . n.a awNa r o•. CwIE Cif MRTM . rorw, ••r, CCNINTr Of OEwTN
SLACK INR •rc. . ~ 1 a.aaa•• r .oa am - oonn oa• r
~lhite , k ~~eb. 4 , 1900 h Indian River
Nj - Q ~ . TO~C OR OEA a.rwa ew area f10S?RAl OR CN11Et eLi - nor w fella, ow! araro raraea .
aracn na a w
~ `jer0 k Yes N Indian RLVer MemoMal Hospital
sTwtE a E>rtM re r•r w...l..., .ura of wlw C01e+tRr wlerEO. NEVER MARCO, SURVNNG SfCNISE ...w. •wn r•rarr rr•rr /
y..4 . Florida `ter .U.S.A. 'M1D~'~""`n' 11 Elsie Dover
SOOAI S[C11UTr N111rEE YSIIAI CK:W/A110N .aw.a taa• o• arpaa •O.M aaaaw• rOa1 a [ItO CN MISeiESS CN e~R)USTtr
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ar.. n 263-12-5375 ~ Mariner 1, F
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4~ w Flot~da ~ St. I~lcle 1., Ft. Pierce ~
~ • o. re w Rt • 1 Box 58
iwtrH-fuME rear .wn ua MpTNER-nu1D[N MAME rwar r+aNr us.
q ~e W. Thornton w Dlcle Westberry
ui~OMwA-ll~ImE w?aNG A00lSS aware oa a.rw..w, cn a w.... u•w. t.r
i~h~s. Elsie D. Stan Rt. 1 Box 58 Ft. Pierce, Fla. 33450
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w Cerebravascular disease 2 wks
A M Diffuse Atheroscherosis Several yrs .
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ts. H. Hoostunand, M. D.
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~ 2800 S.r Ocean Drive ~ Vero Beach F~~arida 2~~
MIUAt. CREAY?tlOa1 REMOVA Etr d CetAU?toer-NAME lCKA110N are a pier saw
~.aa $ta*ial Ft . Pierce Cemetery ,r, Ft . Fierce , Flc~ida
Q#TE . rpww, rr, wr. fYraEf/ll NOME-NAME AND AOORESS ~ a.Mrt oa a.r a. r0., cm 0• rOan., ar•rr, P? ~
_ Nov 16 1977 ,la Yates Fiuier3al Home P. 0 . Box 77
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'I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE LOCAL
REGISTRAR'S RECORD ON FIEL IN THE INDIAN RIVER COUNTY HEALTH UNIT AT
YERO BEACH, FLORIDA
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THIS IS NOT VALID I~ILESS THE RAISED SCAL OF THE ~ r , _ _ ,-y
INDIAN RIVER COU(iTY HEALTH UNIT IS AFFIXED. - `~'"'J~-'~~'~•
4 ~~82 C UN HL H D EC S
1380 .Itlt1 -9 AM 11= 41
- • `~fo ~+c rat o EPUTY REGISTRAR
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