HomeMy WebLinkAbout1648 SU11~0
IN REz Lot 14 of the FLORIDA COAST LINE CANAL AND TRANSPORTATION
COMPANY SUBDIVISION of the SEA of Section 34, Township 35
South, Range 40 East, as shown by a plat thereof filed in
the public records of St. Lucie County, Florida, on the
24th day of April, 1911, and recorded in Plat Book 1, page
43.
DEATH CERTIFICATE OF WILLIAM GAGNON
CERTIFICATE OF DEATH
- F L 0 8 I D A orATrlT Flu No.
~tRTIi NO. _ REGIfrrRAR•• NO.
1. PUKE OF DEATH COD[ No. 2. USUAL RESIDENCE 1wMrsMawsu«a uWUtwre:e
~s~ael
. CO{{N1Y e. STATE COUNiY
~ 0, ~ ~u e.rHe es,eesW I1rNA sieMa lOVLI t. LENGTH OF t. CITY W easW ae.Nw. itrtlb e,tte a ~sLiC i 8
o ~ TowN - STAYItrtWafssu OR ~
TowN
~ g sL [Wll NAME Of +u w eesMet sr rMUrtse. stse sNeM eMw K Iretlse) d STREET Iu ,vef. st« rat4u
M fA 110SNTAlOR ADDRESS
INSTITUTION ! r
1 NAME OR s~ tBtrel) Is. lltliaM) e. (Let) DATE Ilfoett) (Des) tYeet)
~ DECEASED OE
Fi o rrp. « P.:.e/ 'fin DEATN
~ SEX 1, COLOR OR RACE 7. ~~~N lit t. DATE OF NITFt 1. ACE L a ee r nee n s~sas a, rr 2
lsst eti,Irae,l Yerea Dw Hwq eEla
e o ~`•S t3 ~ 1 t
~ IEa USIIAI OOWIATIOWWw tW et wse IM. IpNO OF BUSINESS OR IN• 11. p~TII letsa er hsase eseasfl 1 CITIZEN OF WNAT
~f al wrs rya et wars 1rr? esa tt ssabMl OUSTtY COUNTRYT
• L• Ir ~ .i•K•
• f~r ~ llAelE K MOTHES'S MAI
Z i ~ '
~ IS. WAS DECEASED IN J. S.AWEp fORCESl N. SOCIAL SECtIl1TY h. INfORMANi'S SIGNATURE r
st.aea.r.ra,.ar rusaa«..r.rrw.e.r.teel NO. lYL7 ~.181II--T- .jA'r OIl
3 ; e • • t . ADDRESS ~ : ~ ~
s:
; ~ NL CAUSE Of DEATH 1 ~ 1He MEIDIt:/1L CERTIFICATION rwttzw~
~ Oratvstsaa
w Timer erb ere
~r1.0 alit w
l for 1r1. 11). ~ ~ . _
~ ~ ANTECEDetT CAUSES
-ra:.a.e..«.,n. QUITO ' Y s----
~ - w .ra. e1 +w.. r«w a..liwrs, V tars, ttfrs
errs irasa /e~- t. W sieee ease t efe6
o .eaier~.. sca tt,".. w tie ~ awe Mst DIR TO c ' • ~ • - '
t C aie j~esee4 Wei. M
'Z.,j ~ ~ ~ ~ r • i • i II.OTNEI SH:NIfIG1NT CONORIONS _
~ • Cerltiews eerrtrfirtir~ a fie ~eaf>? lea wet
C ~ .,tar,! to tie lieew M eewZWr ~eati.
Ifa. DATE OF OFnERAN- Iri. f1/1JOl NNOMICS Of OfEiAT10N 20. AUTOT3YT
C ra. ? RO ?
~ X /tlvee?ltt I~eedtt) 210. KACE OF tNJUR4 taL, r s sesst 21c (CITY OR TOWN tCOUNTY) (STATE)
Q 21a. scuos,sr ears, tese?. terra. stwM, s>V ew., rat u oral. Mae TiUi~t.r
j 3 ~ ~ w,cioc - -
f ,eoriL
E ~ ~ ~ ild. TIrE tL+u1 toff rteerl lnasrl ae. INJURY oOCURtED :I .Now oIO 1 uRr uR1 _ - •
C OF rare et rot t¦t?t
O INJURY ~ sreu ? at a»as ? i
o ~ n I hrr.by ccrti/y that t atteRdcd tAs deteaatd Jsow 1)ec~ ?1; 1'J~1--, to 1-r'r. 1 t~ _ I9_,~lAnt 1 loaf aaa t/t~ draaud
w a1il•. na ' ~ _ ~ 'it9 and that death otefatrd at ' • m rom tht rnuaea and oR tht dale elated obol~t.
` B ~ 2Ta SIGNATURE lDesr'ee ar 2Ib. ik. DAriS16NED
~ .r , e ~7
g 1~ R u R 1 A L, CREMA- 2A. DATE 2k. NAME OF CEMETERY OR CREMATORY ltd. LOCATION tCib. font, ee eooab) l8tafsl
ar TN7N, REMOYAL , ~ r,
efYl ~ OATS tEC'D RY l
~L 1E61STRAR'S SIGNATURE l 1f. WNERAL DIRECTOR'S 516NATi1RE ADDRESS s
190 S~ P 2S 1 r' CO
t rlereby cert~Y m'` to ~ a true and correct caPY of the loco
Registrar's record on file in the St_ Lucie CAUnty ){ealth Depa~-
r~tEC tNC FELORUiO
Si.tUC1E COL'NiY.II A.
~nt at .Fort Pierce. F:orda' ROGERPOItRAS
Not va'~d unless ra:'ed cea! of the St. facie CIEItit CIRCUIT CCUdi~
(Warnir+g: artment is aff~Red.)
Gounty Yea~th Dep 6FC~nC \•t piFIFC__ .
r
N_ D. MILLER, N1. n. istcar
Gpunty Heaith Officer ~ Loral Reg _
_ -
pep\tty hotel RpistrAt . _ : ;
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