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t a has- R C1Tr. TONII.ON tACATDN - e. q /LACE 01 O[ATN e. CITY. TONN. 011 IACATION NESIOEMCE
asaeat 1N110[ CITY I.IMITlf NIl10E
tile. YES 110 rael IID~
NAME 0/ (q att la !)w/w. /M ttr•1t •/%M) tlNYTN OF 1. lTNEIT AOOIIE>N ON A FANMt
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1. MAM[ N FN•t Ip//• La1t OATE Xwq ~ Ya•r
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~ JOHN EMI~RT KOHN aAT11 -
. SEX - _ R oouoll 011 MACE 7. ~Dp Q NEr[11 MAlINKO . DATE a MNTN Ait (h N•r• • t*0•A I urot.ll
- salt strllda) x..r. Dt•t raw xw, r
. 1 s . Male White .1oowEO olroNao Oct 1 1880 8 `
ylelal~ 10a. uwaooai?ATION alrt.a•+yr•rl 101. awa oNwousTllr t . anlTlrtna(ar•awlMrMtaaae?p anallorwntaour111r1
eltt far- Iari.I~N~ All.aea~/rnirMl
....as Develo r~ lan'~`~lO~v s Geor is U- A
?laet !at iATNEt'3 NAME MOTIIEN~ MAIDEX
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t„e.rlte. John A. Kohn ~ Ellinor IIisabeth Knox
•AS RCEASEO Evn1 w a s A.MEO . aoc1A< tEa1NiTY Na n. ~t~NAtws Annie Mae Kohn
1Tr.r.erMRwe1 ww.«.......w.r..n..~
- 1011 So.' th. St Ft Pierce
feferal 11. EA11Et N ~fATNI [allltr •ttT, •M te.•r 1/ f (a). talf (d, iNtEItYAL
i t • e ter M11T 1. RATN •AS CAIREO DYE ONltr AID OGTN
ae.t the ~ 1MMEOaTC tAUaE w Cardiac failure
tte ..r_
tttle.s. a.dlrlw,+i..,. D11E,o Arteriosclerotic heart disease
fltt tt• r/~
1 • s a 1 ~ t~•ax (e~ -
reAlssrae ttry/ Wx DyE r0 (d
• i t * 1 • T>> MNT IL Otla 9iI.nCA1R 001pT101R O01NM111N1.10 RAM NII Il,t NBAA1 Ta TN[ 1ta1111tti D~ COIR1110N iltal M IA.I 1(a) . M AUTOKr
sears at- ~ /EAfOAME01
ter Aeatt Sellilit rESO No®
. atlateaa~ ~ 1 201. oESCNnE 11ow w•u11r oocuNllEO. aetar• N41wr b Art / w Art JI dots tN
t• t ACCIDENT Su1C1DE HOMICIDE - .
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E •a et ~ TINE OF !!•a? X•at1, Dq. Yt•r
eed,. ~ NU{Mr a.
f 1yr s.
i wNltr OCWItlKO tar. 1LACE Oi ¦11UIIr k. M •r a+~ea1 Mtlt. 2aJ. CITY. TOMN.-011 t,OG?TIDN CDUNTI? STATE '
AT ~ ANOT~K ~ JW+a, ptlt/[r, tMd. •~at 111,.. tft.)
21. / attendtd •ae deoweed /ram . to ~ atld laet •atr atJ~aci alJ?e on
Death aoourtN at 9 : ~ A. to ow tAr d.b slated aiwe; told M tAr !e•• d auk AwotrA~d/e. rt~I tA~a aaaleee etatel.
All i teas ?ta. MSINTYA[ (Ot,rts w tWs) 22i. AoONESl 22t. OATS S1G+1E0
ere to to
t..,l.s. a Alva D. - Orr, M. D. Ft. Pierce, Fla. 26-64
e e e ¦r ate. 21e. t#•att. aouT10R 231. DATE - 27~t. NAME OF CEMETERY OII CNEYATONY 23d. LOCATION (LT1,. ANta. w ttaatn
Mar. 24, 19 - Ft. Pierce Cemetery Ft. Pierce, Fla.
r. s. ~ 613 2{. tUIEAAL ON'S SIGNATURE a er ~e 26. DATE NEC0. ST tOrJ1L REG. NEWSTAAN^S SNiNATUAt:
R••.lass Joseph W. Yates, Ft. Pierce, Fla. - 3-26-64 - Anna Lee Denison, d.r. s
1 herby certify t[1it to be • true and cornet copy oit tfle (,O(',~1 . • .
ti;epi~ral's noord on fik in the St. Lurie County Hesl[h Or~rt- }
malt at fort Piera~, florida. f
f (blaming: Not valid unless-raised ss~l of tFls St. Lllt[E) - ' - .
County Yealth Department is affixed, _
- - - -
N. D. MILLER, M. D. '
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County Heatfh Officer. li Loael Rsgbtrat ~ .
v .Duty t.0cat @OltfrM - °/C~11` '
1~ ~/!/ri r,~~e.
198D .lUl. 25 AN I~ 32
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