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HomeMy WebLinkAbout1540 ~i ' STATE QF F'II,ORIDA . 492"00 ~ o~ . - DEPARTMENT 0~ ~.._Health & Rehabilitative Services . ~ _ ~'~`~`RiC'T NINE PALM BEACH COUNTY OEPARTMENT OF_ ' PUBLIC HEALTH • V 1 H~ 1~ CERTIFY THIS TO BE A TRUE COPY ~ ' ~'~1 y •r ~ ~IE RACAL REGISTRAR'S RECORD 901 EYERNIA ST.. - ' ~ WEST PALNt BE/1CH~ F'L 33401 , Y' VY valid unless the raised . • ~ . ~ ~ ~ - ~ . seal of the Bureau of ViW ~ d ~ - 1 r Statistks is aiflxad.) ` ' DEPUTY REGISTRAR . VITAL RECORDS UNIt ' CERTIFICATE OF :DEATH " ~ - - D.../,....~~........~L.~E.r..,.r.EW. S 9 v.r.~ pAE.EEN:. F L O R I D A. • EDGE E1EE Eto. a tEl«r rIDOEE EASt sa wrE d OEAM rr.. w... ?..l .,E,,;',t,,,/ r. -RALPH P . LOHAK , MALE ,NOV .25,1979 EIAC[ Itt EKE-. e . MI?ly_ Wt~-- •6E-Ew. lt.rM./ 1P~EE 1 1/Uf ULVf E W. DALE OE NIIM /r.. 0... i..J COENIY OE pE•M _ _ Aw. l..mew. .«1!S/wJrl fr•..r -IM06 ~`Qnir3 IIOEA 1-rMlS • WHITE 76 _ _ _i_`1.. APR.10,1903 PALM BEACH Ctft, EOWN OE tQ(A7tQ.,1 EIE OEAM /1OSMt1El OE ODIEE 1•(tll r{rllpfi-/yy /fI w w MM.. MI .r•M wI..~M.I I! /Oy QE INS, /I..dt.Y OOA ~ a 1 PALM BEACH GARDENS PALM BEACH GARDENS HOSPITAL D.'r....., w.•~.••r:N../•I n. _ INPATrENT ' 31ME OE MErN /ry.r s. Qfl[tN OE W1Nr COWTEt rAMrrD. MviE MASnEO. SYEVIt11Nfi StOIA[ /r/..r.. ...t.. ....1 - . ns.._ ........171 wt°orwrD. avatrD rs.w;),1 USWElffgtN[E • RUSSIA USA Te. MARRIED I1. CONSTANCE .DRENNAN ' lrW[D ~ DE~fN EOC1Al 3ECyElEY MIE.EIE OCCVfE[D wt UJWI OCCIIAt1ON /C« 4./.f .rt 6•.•. Lqa Oi eJinAif OE ,rglSrEr - wr M .rly rll.. ww ..r../1 o rt 109-O1-9278 MANAGER r, HOTELS r~ nsaENCt-.tr•Tt cowry tlrr. rowN oe tourl°N IEEE ANO NIMIEfR I.fsw[ a*r uwn n...:.~ rw r s./ FLORIDA r.?.PAL[~1 BEACH LAKE PARK 736 WEST JASMINE DRIVE 1.. •YES /ADIEE--NAME EIES1 MIDOtE IASr 11EE-MAIDEN trA.E[ tlKr MODE[. EAST 1 ~s NILLIAM LOHAK -ESTHER KOHN INtOEMANt--IMME IIrN r Iwl IIING ADW{SS SiEEFE Of E f D. ND. CIr1 OE ~O'MrN St•tE tM CONSTANCE LOHAK rr•- 637 NEST JASMINE UR., LAKE PARK, FLORIDA 33403 EUEIAI. CEEMAEIDN-lEMOVAI.OMf rS.wyll C,MEEEEn Oe gEArAtOEr-aiAME lOG1tON Crn/ p tpyEy STATE . 1k REMOVAL BURIAL- r« BETH DAVID_CEMETERY ,k ELMONT, NEW YORK wNEU.wEEVOe~,:,..."' tE.1EEAElIdIIE RIVERSIDE MEMORIAL CHAPEL r+r ~ ra 4714 OKEECHOBEE BLVD. WEST PALM BEACH FLORIDA33409 ~ 7 w. rl... ry •+..1. f .I.e+t.tcrwd 1%•.f .rd d Ew1w .t ...w..w..w r•l)r ~+....y.•r.., w •...c+•« tf.... '~I 3i ..+d .b. a M cw. J m..l ` tu.M M •w...V +.i .E1t.../ bw M ce...111 •vri I DATE sw1tED lr.. 6.r. /pU! Oi OEAM ~ ~ MtE SiGNID rr... DJ1. ?..I NOD! Os DEAtN NArEOlE 1/?9/79 ~ - 3259 A. r ~s a?. _ n•_ r' 4 ~ F rWtfO EM75KUN 1 OtI1ER IrMN CEf11tIEE E,fN r..+11 ~ ~ EEO.rOU<EO DEAD rY... er. 1..1 .EONOI?aCEO DEAD lt..., - r ~ a ]Otl _ ,~,,,,Lr ,11 ON 7N Ar r NAME A.ND ADD.FSS OE CEEfrrltE IMrSICUN. MEDKAI E.AMMEE, (,7. ",...rl SJt;1 CJt P • BY•OCIC E A'1. _ ~ „ 2601 rth Flagl r rive, West Palm BeachE Florida 33407 EEG1SrEAE f ~ DrrE EECErvrD a• .ECrsrw rr., n... r..) (n•101rrO.4 - - - --,lQ-= - _ suB-R . DEC 3 1979 NNfN W VE 7. IMMEDIATE CAIAE rft,u n.,i O.l. C.CSl. I[I utt IOI /.1. fEl. /.O a/.J ~ E.•r.li 1...... r.~.. w I1... t~;E ro '""FD'"'E Acute Heart Attack ~ Minutes CAUSE 1.1 1 $T"ryNG tN[ E ~ UUCE1tU13i DYE ro, d As ? CO«SFOUEAKE Ot. ~ ~ r..r..f M1.w .rwr w d1A i Chronic Auricular Fibrillation -i ouE ro. a As ~ co/aEaIIENCE a j OV er 1 ~?aar 1 I.+r..E E.1.. ,I1 .I.M W 11.e1 ' - M _ ' . ?IET OrMEE SI~rItICANT COndilOra --Cw/..w.l d.... Err wr wia.d w taw. , t w c«+..!>w+a r..w ..,AE111.1 AVTO.Sr'I:r"r'1 ~.iEi Y.%s...,r. ie rrEwul l Hypertension _ _ _ _ _ _^,.~>s NOr~ LNO P.16.?1E1 ACCIpENi. EIMIDE MtE O• W/lrEr /M.., e... r..) NOME Ot I.UUEn O[SCEIN IOw tNpEE OCCEREED td1KIM, r UNDEf[eMN1E0 ISNc.r.) ~ ,7. 776. _ 77c ` r ne ' `•1S f_... SI,. MAAr Ar 1IYOEE (S..n/. E'" .IACE Ot INMY-AI M~.e. b..r. •...e.. 6c...p..Np yr~,,,e. lourgN StEEIE Qe tED. N ptr p qw( SiArE r o1w. OKV3 ~E~ t,.. „t. j7D - _ _ - _ _ _ ~T_ 49220t~~ f ~ •JlA. -9 PM I= 09 - E ~ ° ~ ~ ~3~34 P~~E1"' 3 ~ . _ _ _ ~rw~~F