HomeMy WebLinkAbout1147 ~~~~sh~ ~uRewu oAF vlt/?1. s-rwTncnce CERTIFICATE OF DEATH ~491La~v~~ y
,.aal ter- FLORIDA
or3 when f+JIRTi1 NO , REGlSTRAR•S KO
properly 1 /LACE Os plAiq CODE NO. 2. YSU'Al RESID[MC[(ft?w•as~..dh..t /'...aw+.•. !>..t....se?•.a......~.J
e r e c u red COUNTY • STAT( CO:.~Tr
snd •11f ~rort•t?rCi l[f~nJf Flnri-c'a ~_-O•••I?`-'~
pe plated - - -
in pef- A- CrTY• TOWN-OB LOCATgY t. K KACE Os DEATH t. CrTT• TOWN. OR LOCATq•r t- 6 RLS~LiKf
INSIDE CftT [f~fTSr MItS+'X Crir t:~:r~r
iii:pt fiOllvt•/AfT~ res~ wo? `~ira!*'ar ur
1- ruME OF (IJ woe iw brpital• /cr Hrrrt aldrrrU I. STREET ADDRESS
MOYITAL OR •
p15TITYTpN ~•e*~orizl ~~OSnlt?1 2410 ~'T Al.'Ca(ji ] j?ri~:n _
7 MAIL[ Op lint -
i-- /Ni4dlt L•d 1 GATE ~[satk D4 Yra~
Cis
p[C[ASID C'a'r TT1fp pEATN ~f Q UFO
(Tjpe « print) ,T(? r r . 11 ? ~ _ arch 1 , ~ J .
S SEY 6 CO:OR OA RACE 1 t GATE Os ¦IRTH ! AGE (la start s uArt r rife ~.~A;. +oz
MARRIED t7 MEYER MARRI£O IsA! ii,.ta:ljl y..ra• J>sa. tr.v N
¦ r 1 t . 'talE' Cau wlDOw£o~ avoRCfo pearC}: 31,11396 72
p 1.1 w l7 IOe uSUAI OCCUOATrO.r (Girt tiav of:ort Lowe Iyi KIND pi BJSINE55 CR IND`JSTRr 11 fa1R7MifA:E (Sra/e R prrrjw tf>esJrj; 1Z Gr.ZEw Dr tqA: Ca.~'~•rr
•1th per- (aria/rwoKOJyortlnyl:Je•neaiJrttirrl)
¦anent ~arher el£ F:T^nlo ?e~? Italy U.S.A.
)lick !pt 1~- /ATHERS NAwE If. MOTHERS MAIDEN HAVE '
OT
t~pe.riter uno3tainable , un~abtainahle
16 SOCtAt SECURITY ND 17 fYiO.IMANTi ¦IGNJ1TYRi dl4rn2~1,J P_rcac?ia '~rl•!£'
. _i
G~1~• 2SC~lC T~!°i lI ~~-:-L'.~ ~
!1.~~ *"irar'ar, Florida 33C23
/uneral 10 CAUiZ Os CFATH ~l:atu Dais owr~ asst prr lira l^r (al. (tr. anE ic).j ttrtER: A~o£S+
qRT f. D£ ATV wAS C~tl5f0 8r- ~ /
¦ust`[lle IMMEDIATE UUS`~It) C``~tlt!<~ --`-~•r-.>'-lei-~-~i!~i tr -~r„?
tlflcate Cealitions,i/ens. WE TO (D) ~~~nS(~~7"~y ~~7~~1~~y-~L=tS.-_ 6~f S - _
¦ 1 th the srdicA /arc ruff to - _
l e e • 1 a9otr cane (al. _ ,
re lstrar atviz/ fRr tn~rr- -
8 ~ Ijinl tati,r far!. DI,E TO (r)-,__ _
• 1 t h 1 n T2 O /ART a Dir.i.R SI.AISKAAt CoAat?~\S CG~'R:-:Jt{K ro DlA~N 8 ~ Aft RMR7 TG rnE Tfav:Vt a715iJ1Si x~.tii:Dw G`?sA is?• t;ar - 'sAS A~,;,rr
lours af- 0 f l RERi0i4t'
ter destA u tt 1 / - - p`t
~ ji: a~fj•?Tl~ V~ ~~/.}•_~t.~i~_ ~JLr_1 i' 1~~~ ~ ~~r-' ~...s~/ r- 7f5~ ~u
or De fort s< - r-- _
~y lRcLrD'J) 2~, OfSCR~BE /•Aw J.Jy2r C jaRiD !Ew er aacrr aJrwfs•j ra Hart Pert I Viers tj
aatlna an] S ~ACCrO£AT SUICICE NOV!CIC-e C=
dispasl- rr ~ ~ ~ _
C 1 On OC V -
lod t Lac T:IIrE OF Iloar ~tonri• IJOj• Ytar f
IIp' o p. A•.
i Z 2'),! INJURr CCCURa£7 20r RaACE Cr INJ!•~r •r. f in sr ai ,r komr• 2+Sf CITr. TCwA- Oa :OCATgA CTriA?Tr S:aT[
WH4E AT ~ rrOT MH lE ~ Jarwa, lodarT- r•rrrr, cr4rr mod) , tt:.;
MORK AT YIORK p~ r/ n
21 / attended the deceued from / IL-~r-'to ~ r
• ~ '1 • 9F -Ind lut saw ~ wl:•e on - f~' r 1- f'r_~
F ~ ~~-:~y " - / Arm ~ r -
DeetAoccurred •r ~ • ~ n Tr_'_r___! - m on tAe d.ra stated abo•e- wnd to the btsr of m~ kno~lwdje. lr~m tliw u:.*ars sra:rd
111 peas ~lIGyATYAE
,~s/ M•r•ror~i•!r• 229 A7J~tf55 Z2r Da'f 5'~z3
are to De ~f 7~8~ /~Cr/1/3~d~~ ~ >
c o a ~ l e t e a .~!~t'~-,~~i
_n • •~-`~~•`-L~~f/'"/v ~erJ~r. e/I'rt ///v =s ~iC ~ • ~ 9
accut•
2i)`9'~:w:,_.:a=_rar:.n 2'l~ DArf 231 .rA4 Gr CE•r£Tfar QA CA£vA-~ar 231 Li00.fT+CN 1Crj. rr a. w ta_._•j- (3_r.
3 `Err-raL ltiK•r: rJ,l •
Tan. Orl=ti ••~r ? 5 .1'-'F~ _ '~ronx r tip::' Yor=:
P. 3. X612 2• i AcRAI O'~EC:JR S SIG9ATya[ r1 ~~5% _ r 25 DA7f RICO ¦I LOCAL Rir. 25 RtGIiT-a? S S s-:.f=
V r ( T ~ r/ J~
Rev.lOtiS ~ . .X~ti
e G~~-~!~•. ~ ray= a s•~ ~ p r ~ : ~ ~"~,t~. ~9~ y %~I.E-a f ~
~c6„
C* t:'PI~'it:i) COPY
I hereby certify the above to be a true-and correct copy of the :.ocal
8egistrar's record on file in the Bro-+s.rd County Health DeYart~ent at
Fort Lauderdale/ Florida.
(ldarnin~:•• Not-valid unless raised seal of the Broward County Health -
~ , 's
- - , ~ ~epart~ent is affixed.) ~~D J,t~ ~8 ~ , ~ TT t
s j ~ , • - j ~ it M~ - Ira `
-t _ • :r •
ivr U t= Counter Aealt Officer and I~~4ati'ii~~strar~ a
~-.~~oe4~~;~ _ D uty Local Red;' tray '
s RLZGeDfD 1110fRCatrl RfCYKtDS 8hi~
• OF (F'(KARp CDLVTT F1DRS.^,A
- 9UUK ~h~U PAGE 1145 J=~ (•K ~t'HF. F. I_ F_ R
_ v~ P
L _ r-