HomeMy WebLinkAbout0348 ~951~0 { L /
T
Re : Lr7t 16 , Block 1'i 3 , POP.T ST , LUCIE SECTION 21,
a subdivision accordinP, to the plat thereof as
recorded in Fl~lt t3uok 14 , page S and 5A through 5I
of thc~ public records of St. Lucie County, Florida.
rORM V.M. NiO. I.A COMMONWEALTH OF KENTUCKY
1~iav. ~/w osraRrREaR a NrruTEt t~ w? lli
o~?ICa or vrrAt Mrwnat,toM RIOT ~ /
CERTIFICATE OF DE#TH -
Reeetr.tle. DYttkr Nw ~ ~ C ~ 1't1..ts RMIMe.llra bR14EeI N?
A rletl ruw up St1( GATE OF Of/1TN IroreR e+eR. tewl
1. MINNIE FRANCES HUSK Feaele Decewber 16t 1972
arlre, rNeO, ArWWI IrM•tt, A6E-utt Yrgt , rt.t Yrgt , wY DATE OF {IRTN trornl, W,
etc. Orecllo rurMr n1Atl~ „p,. M•f roYy rlr. teAet
Y sb. 4 sb. s<. Se 4 1 1r: HeRd Oti
. O 1OU110N OF DEATH rrue/ an lrr~n HOS?IIAL OR OTH IN TITUi r rot p tllltr, urs ntllr JN Iwrrlr
}ienderson ,d CowiRUnity Methodist Hospital
STATE OF {IRTHur rot Ir •.la., CITIZEN OF WHAT COUNTRY MARRIED. NEVER MARRIED.' SURVIVING W Irtl<otw rANOr rAree
'"u•: tnrerlee rAre t0wtan WIDOWED, DIVORCED wKlln
"'tq'~e•"' Kerauck USA.
,,.,e. qAt„ ,D" Married TT, Herbert Husk
oc< unee ~r RI1Y NUM{ER USUAL OCCU?AiION raa ure a rroee port elww roa a KIND
uyr~•ytIQM, MA tro[uN U I `V~ 4t1[eN
Mt~tVrQ eerou It 40 -b8-b 0 T7o ~}aC[iine o rator ~ 11b Crestline Plastic Cor .
Aar~utor. RESIDENCE-~STArf COUNTY CITY, tOWH, OR LOUTION IMtw ctn urns NUM{
I,o. Kertuck Henderaon , Henderson ~~°tra 029 Gre o Drive
FATHER-NAME reeR t ruw eAU YOiHER-MA/OW NAME wtw rwv t~lw
Ts. Waverly ~nley Luella Mosley
INFORMANT-NAME MAllIN6 ADDRE3i MtefR( oa uJl. MA. ie1Y Or 10M1. wATR, RMs
Tls. }:e:tert Huak 2029 Gregory Drivel Henderson. Ky. 42420
?ARi 1. DEATH WAS UUSED {Y: (ENTER ONLY ONE CAUSE iER UNE fOR (o), ANO (c)j ' At
IrrlelAte (J1Yle
1ej A/'c'crf~r/+~ IA,E'~~s-i/r.rToj~t ~ ~"1ovIN1
to oa w<w corlevllera a: " (
mrarloia M Al1I, 1 Y E
A /M J'
snncr s•w rte to (b1 O/ ri ! n,Y t, r s .^'t A ~ ? /UZ (J L
IrrerAn cArle 101,
et•nw tre tlret? rM t0, a At A ooreWeern a:
enw tAllr IA/
icI
TART II. OTNE! SICNINCANT CONORNMIS: cwrnoa cortrwnro to gArw err rot erwtle to cAYta MrM M M41 [O) AUTOKY li Y!i srtes nrMNt C0~
irti 01 rOl rer M ewMrtrlN tAM
n 0 01 eeMM
A 1 1 NOM IGE, DAtE OF INJURY Irtrrtr. Ht; reA[I MOUt MdM/ INJURY OCCYLREO Irtlse rAlres d MJMr M Mt 1 q IYYR M. tlrr W
OR YNDETEWIMEO Ivscln) ,
100- lOb. et. 1Dd.
INJURY Ai MtpR[ RACE Of IkJU1Y •r r•OrL rur, Itew, r•noer l0(ATtON (Truer o~ vi. rD~ dtr Oe tow, etAtsl
(r'eC1R Ys Oa r01 anu ewo.. BC. twanl
l0i
- roar tAT YIN rortr oAr rw Art Wt tA71 rrr/ree ALre or t Ne/M~ rot nes+ 1w eMtr oocreee0 Y M INKt. Or ltre
?NYSN:IAN: rartr w tw wa Arra w~?m. wIL err. t0 ns oet
o. etc1A1~ rsor ~ 1 i/ /91/ 21b. Il i L //1 ~l ~ /1 / f~ / I 1 Z ltd. /~/O'f ~ 0/ rt eraruera, eA
- ONE : or rr[ uwl ar rw wore or oe•rr rw eeceertr tiAS Ieorolltlc~ sw
aAr~r•nor tie tra pr? wre/oe trt uftsr~c•now. ~w r. phr,or, rortr M? rW MIA
tl•rr OGCYYO Or ItY eAre wq ew to tw Grulrl FAtee,
CERTI 1 ipw oa rnyq 51GNAT:1 / sews DATE St6N rnr, Ywl
1b. r. •a ze ~ . :•i les 1Ib. !)e. s ilst
MAIIIN
na. :1G r ..treat, I¦ rial°~~~~."°' F.erd~i Kentucky""" 424
/URIAL. CREMATION, REMOVAL fMET Y OR CREMATORY-NAME LOU110N atr oe tolrr euas
rl.ectm
110. -~:rial ?t Fernxood =edeterr~ 1~c. }ienderson, Kentucky
DATE ~ cr tr. !w N DIRECTOR-Sf U (ZI Op
sec . i ~ 6y~/ S10 2n~~ , ~e Thera on . Ky . 42420
NAME OF EMtAIM N 1
25b. 2r1 •1 23 r i 26o i NA U Y/i weacareset aw
I, Paul PS[•Nosse Funeral Directoz, hereby certify that this is a true photostatic
copy of the orSg~p$death certificate of the person hereir. railed and filed xith
the Ce pe rtil~~ p~-~E'glth. .
~ ~
- 'rw~r - ~:.-mil ~ - ~ . r
if L
cscrioe_d;~~sa'io>FTIr- :o ~~ore me by Paul B, ijoss this i8th day of ~ecelcber '_~72.
`rte,
FlLEC AHC ~f CU~~~f A • - . .
SL LUCIE CGUN f Y.f l A.
ROGER POITRAS
CLERK ClRCUlT C!•CR'~
e} ~oi •~u PacE
~