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494388
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CERTIFICATE OF DEATH "t'"'""'°'
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wrA~ .r.n.nt. F l O R 10 A rota rat tta
f"t f1tg0lNE-++tw (tw ettoote tAfA u: ale a a•n+rr., w.. r.J
a rawi
rter: ttta f• N S Female a
etAac wiE ace-+.F. war.
M~.d?~ Aa[-n~w+aw was t rw voce t eAr ern a wfM Ir... w... r..) a~v+n a ouEw .
' ~ ~ ~ ' ' •Dec.- 30 1906 Broward ; ~ ~
an, fowt p tt]EArtow p fNA1M ttorllAt a oflfN usnnnwr-+w nI r ww..•. "',°Q~I,~.~e 1.'~r.:
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~ ~ ><-Comm ' t Hos tal Of South Browa d •
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awtasaE•+a e• S A. ~ Nidowed ti• None
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t• t• oward t«. Dania tw. 205 N.w. 1st Ave
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t
ivttewt ' ttwreAt iotte - Hollywood, Fl.
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nwn EtGrtto pr... tr1. ?.J otwM ~ tfAfE •lO.1E0 (r.. Itr. i.J loin Or otwm
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rwitOt W1fE N. wreaAn awtt (prtlT OXL? u.s utuE Its tYf /3e (.A iX I.J.1 1
tW.EW'~ E IAK W ~ 1
f Cardio-Respiratory Arrest i M;n_
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« Cerebral Thrombosis ~ IIav~
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w Ate s s' s
IAIf Oflrt! StGMRU~Mt [O?r01t~O16-~4.f.+r s+i+~y r isr Mtt .w...1r.d r sw. Yww r. ?Aer 1 M AurOKr (sr.~.I, w4t CASE tEr[tt~ t0 tIEOKAt -
w ~u r r) E7tAMINEe (sr+.iy le r X.) •
IS. M-
~ t~~ ACCOEIR. AKrOt OASE Or wARr !r._ A.7, r•J NOUt Or IrAler DESCfieE 110rr wluer OCQItlED
~ ~`ICIDEa - voETEtatuED (fl.ri?)1
~ aw ~ r na.
135 rww. 51 Iltllllr A/ 1NOE[ ( rn MAC2 or lltltltr.A. ti..+. 4~. Mm.. iarry..Re. ~.~fwe. IOCAi10N SiEEEi OI Ri.O. N.. arr 0e tOwN STAn
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' -.'f~..la:r. C1;RT1F[L•'U COCY - -
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I h~r8tiy •certify ;t~ye above to be a true and correct copy of tl~e Local Registrar's
reoo~c~"on file in{t~e`Broward County Health Department at Fort Lauderdale Florida.
(t;~~j~it~g-Not valid_iiLnless raised seal of tl c Brc~•ard ~r• my/ty_al th l~~t..is affixed.)
1-31-79 . ~ _
• County health 0 Ci ter and Local Registrar
ri
j
~
• ~ Chief eputy Local Regi trac
. - - -
494388 .
9
1988 .AlI. 29 PN 3 3 i
SL E t M POIT A.
CLERK CNtCUR
RECORD VERIFI[0 ~
X335 P,~2167
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