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Depal ~ • ~lE oT liealth and Rehabilitative SeE~itea F L O R 1 D A *TwT tc stts No.
V1TAL STATISTICS gEGI1:~AAq-a No
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CttTltlEt--NAME Il•M O~ 1 , i __i aKwal ya.lyu i A E SIGNEO 1~
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•UtlAI. CtEMAt1pN, REMOVAL EMEiER Ot MAEOtT-NAME IOCAt1pN (nr p Iwr - lr•r/
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Il. GreftlatlAll x?_ Ft. _Pierce Crematorium.=ice ~r+- pierce, Flnrir~~
OA/E r ro«I«, Yq n•a ~ iUNEtAI MOM[-NAME ANO ADOfEif . srnn o.. r • «O , tn. p ro~«, sr•u, tr ~
_ t. 11, 1977 EE. Yates Ftuieral Hates Box '
t/.$. }/Ot2 itR1E Ji! - - R((;ISItAt- SIGNAtutE OAtI brlD ar .pcAl aEGnra•a
Rrr. 7/78 ~ - .ia'C•/i Il. %
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I hereby certify this to be a true and correct
copy of the Local Registrar's record on file in
the Martin County Health Department in Stuart,
r Florida.
1,`' (Warning : Not valid unless raised seal of the '
~ Martin County Health Department is affixed. )
l: K/-:
Archie McCallister, M.D.
-
- :t^.' County Health Officer Local Registrar
-
_ - .
- .
_
- ~
~~4~+~~~'"~ ate ~ De ut~ Locale Registrar
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49`71y
X60 tiUG 25 AM 01
F{LEO ANC PECt2FtDF0 -
S T. LUCIE COON 1 Y. i t A. -
ROGER POITRAS
CLERK CIRCUIT COURT
RECDR'3 ~fR(FIER_..._ . mi, _
sU~337 P~~E 665 -