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HomeMy WebLinkAbout1591 so4ss~ CER?1FICA1 E OF DEA7N y w ~ i owl tKt F l O R i D~ It.,l tsar rte '•rl MpgN1--NU?1 IUt1 ultoll • Utl SI. M\I (,('•1. •r. n., P„ ( V\ ,.r.WN1 s hrtiatar I;arhAt.o , i:alp _ ~_July lU.- 19A0 _ t.(/ •1..Ir..., tl.tt +GI-1+.. t.'•.YI {p~1.1 .1.. '.r.1N.1 Wr pall ME'11M •N-. 14. 1•• I>p)•.t. •N •r i Z •r IIY«.h• (S..I NOS ~1 OA.1 /OILS t ~"/l i;-~'~ 'hiLe 5~ ' - ( ()FUk 1~ 1')2^. Broward _ - `E Ut.. IpMN w Ip[.1t(.•, M OI.IM e06.na 0• QIW! NQ••,y(•eS•t- /y.-. UI .r .ran. M• r.... w....1 ~ n - 1 Noll 37 Thomas Road , Sut/ W WM n,.r w latutN d WNAI cawu. .IAnuO. Nlvlf wttuo. SU.vlv,•.G 9pt/St m ..r•. n....r....«. } ~ , ~.~...~.r..? . W roON10.OnOt(!O t ~NrJ.I ~'`'•Il~o,•.(t ~ ile~~i York USA HieiOtlrCd ,1 _ . wctASte ~ ,r OtAtN ~ IOC1Al IF(lltlt. N~•Mtlt IAAI.I OCRMA/ION I..+.I 4•w rlrO p tVUNlSS d W.J,ltt.r ~ •,t'~;~.;~'i':kI°oi'tl Ob0•-1 -12 1 I U Customs ~ervic:o ~ Civil ;;ervi~:~• - _ •,v ss.oN nsso[NCt.-st.u ctlVNtr csty, ro.•.o. IIxAIIIV. •[In A•O.pNtlt ~ • 1.. Florida 1» IirOe7a1'd ~ I1o113/WOOd s.+ 37 1'hanls i?o~ ci no.. tA111ft-?YM( 11.3( YIOOII 1.51 vOtMt-wtq/N NAII[ nK• NgOl4 I+S' IS Jinceht lornato /E Lill.tark _ i'~::-.io ,rMpWNt ,uWf rh?. l.w? YAIIMKr At10.1 SS SIf1t1 M • I O NO Car O. 10.,•. S'+'f t' I)? $ 3(,n allliJl iternlto - - 103G hunter. Ave:. Valle: ;stream ~~e:~ York ~W+M.t.WUpN, ttMOV+I, plNtt rl...J./ CfYttl.. O. (tq.r.lpr. '•.NI IOIrtWN Orr O. TOWN SL*1 curial 1« itollyrN~od Memorial ~tdi>IS. It( Ilollytrood~ rlol•icla_____~ . atul a t o.-Ia.....•., p wN(aA( ww l;oyci~ s R1I16Y'~ ii01~1@ +oo•iss - - - 1~ ? ~~,i G ~ ~ Gl/OQ Ito od Blvd. i:oll ~,~ood rlorira ' O:J JM1 I~ .ti. M.. /...I..Ip. d...1. w( . r i... wr( .w..+....,... ,n. C+..?. V...+ W « ..•.+y..y. -r K . s fsy..ur. W 1(..? , s `f f3ltMlw W t/1tM , A~ ' r ~ 2 ~ L ~'v^ i~l 0.1f W.N[0.11.. 0... - ~ p"a:iw - ~ OAIf yfjtp (N.. h., 1.. - - •K•I,. I( - I3etween 2:OU and ~~f t» - - - - - - ~ ~ - July_ 13, 1980 :1( 6:00 p t s ~ N...t fSI AI ll.QN.G N.ryCUM It O1Mt hNN t1.i./1tt I i.M r ...,t = e ..O•AIl210 M AO , N. , n.•. 1. / rl,p•+dPK10 [ I.O . - _ ti+_ON July .12 t --1980 tt,... - - 9 ~ 42-- a wY[ ANO ADWf3301 Cfa1tIH 1?•..SKIAN- MtOKAI htAMM/(tl /1.?• - n..r• Shashi B. Gore,M.D.,M.E.r 5301 S.W. 31 Avenue, Fort Lauderdale, >:L 33312 ~ .fusnA? ~ (u,rn•a;ra•••rc•v+•.••-. n. l•, k r~....~ c_-Stc_i•cL, ~h ,n_~_~ :x July 15~ 1?:3c: ,~.y. .r.ItWAR CADS[ - 1/,.1r¦ O\II MI I IUSI Itll L.! R r. 1. QL I(P q11 1'-•. Gunshot Wound of the Head _ _,_`1Hinutes _ , t:. ~:..~~...f - - ,•.ct. t. ~..c IIIN ro, of u A (o/IS[QI,[N[t W: 1 t.,.... ~ 1 - oUt a, oto. AS • coatartwt[ or. 1 •ww tv,.«- rw• e.+ a.++• 1 _ . ~ . IANtt OMt. SIGNtfKAM Cp,01(10N3-Lr•br~w..w..~w'Y 4+eMM ?•++p .•4W v(a.w. i•+e•wMn(M .urO•S. ,t(..o. ~w.S US(i[([I.rC tO NtWCA( ~•waat ~cc,ptk(. sltcrot « OI11t M nvllft'.,r.. r, t •rOI,. 71 /NJIMr Mx.~u .tOw tN1U~. occv.no I.oNleslx .•votlt.Nt.,to .s,..y,e Tact. 2 00 ' tom. ~/t. [n b 6:00 a _;suicide 7 _ ~ July_ 10. 1980 _ t?+ Self-inflicted gnnshat_~round _ > - ~ (NIIKr Al ..ptr /sp..r. [n !WAGE O! Iq,u.r_u ?rw. /...•..w.•. hc•.... .N+(. t...t.^a. IOfJ.t10N t(.11~ oa a (o w U•r O. •o ~,1 - v.r( i Dacus, ~n. NO ~ ~?r" Home tt 37 Thomas Road, TiOlly~:0od, F"L . , :scat n . E . ~ C$RTi Fi IsU COPY R 1 herehy certif~?,-, - - -is. a true and correct copy of tl~e i.ocal Registrar's record on file R ~ ~fliealth Department at Fort Lauderdale, Florida. (warning-Not V ' t~;'I ~~s' 1 of tl a Brt3 `ard fan my 1 .al th he t . i s affixed . ) :y~'~t7, .County Health O ficer and Local Registrar ~ 8-Z2-80 Chief puty Local Re,gi tray - 3 E. f.:.•,;_...._.,-. T.It•-sue ~ ---------r • - - s SQ466'7 - - " 1930 QCt 24 AF6 54 . fit.Ev^ iFiC ~rt:::R:kEO 5T. I_l'CIE COJN t Y. F t A. ROGER POITRAS • CIERIt CIRWIT CGU t - ' ' 4 ~ - - - - - ~q~ ; ` -