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IN RE: ESTATE OF
LEO M. CAPRONI, SR., DECEASED
Lot 24, Block 148, PORT ST. LUCIE SECTION 27, as recorded
in Plat Book 14, page 5, public records of St. Lucie County,
Florida.
OHIC DEPARTMENT OF HEALTH f`~ ~ $ 13;:J T.4.S. !
R» wl N. __ ~ ~ Q~ DI :ION OF VITAL STATISTICS SLI. ~ ~_ _____ _^
P•r.I..TR.. ~.~ Na ---- CERTIFICATE OF DEATH Rapp«.Na _ -- -_- _~ _____
~OECEOfNT-NAPE FIg1 Y.Idk Lan SEX DATE Of DEATH ly... W/. )•,..
,. Leo M. Ca roai 3r. ,Male Pleb. 24 1 80
RACE-N>.,WMn,0l2e-,7AnrMF AGE-l2H BrVIAar UNDER 1 YEAR UNDER 1 OAY DATE OF ~IRIM /YLL,Or,,Y[/ COUNTY Of OEATN
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CITY, VILLAGE OR LOCATION Of DEATH HOSPITAL OR OTHER INSTITUTION-NrN fJJ.et Er A,W,,lw,bvcr W rrrlNy If NOS( OR INST. I~.M DOA
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6TATE OF ~tRTN /lJ I12, 21 U.SJI., ,•r.l CIT12EN Di WHAT COUNTRY ORIGIN OR DESCENT INM:r, (1Ma~c211, G2/.wr1, Elyli,A, CIIOa1, SOCIAL SECVRITV NUM R
.+I+r,1 Pwlq RIC2q 2It.1 IJq,Iry1
d. ntu ~ .. 10
WASOECEASEOEVERINUS.ARYEOiORCEST MARRIEO,NEVERMAgRiED, SURVIVINGS-OVSE/1J.pF,pwwrWw..~r/
fYesrwl+tv..l lU 7rA 2h+Mw y,lA2~r/ W1001fE0, DIVORCED lsI1rY)1
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USUAL OCCU~ATIO
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RESIOENCE~STATE COUNTY C17Y, VILLAGE OR LOCATION STREET AND NUMBER INSIDE CITY IWITi
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IV. OiJiO 120. ~~ 12c. tb 1
iATHER-NAME flat Y~2k L2/, MOTHER-MAIDEN NAPE i-,r J/y2y Ian
Jacob roof ~
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NfOitYANT-NAME/fy,cwAil/ MAILINGAOORESS ISTREETORR.F.O.NO! K:/IIGR701YN) 15TATE1 Izr1
Clorioda Cs ni b607 Old 09 69 ffi ~ Offi
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-AAT 1. DEATH WAS CAUSED BY: IFNTER OIVCYOWE CAUSE IER LINf FOR fil, fbl, JINO kl) ~E~EM p~i6Eilw~iao oEAAiN
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IMMEOIATECAUfE 121 ~ ~~\I Cafes - i2tir ~ a S~t~t` >`a.~i a.-
DUE TO.011 AS A COHSE MCE Oi.
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-AAT II.OTHER SIGNIFICANT CONOITI :C IMpYMKIrq/,rM 2r11y, I•Yfr/pttal,l,IwM .. Part/pl At.T/IPSY WAS CASE REfERREO TO CORONER
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ACC.. SVtCIOE, HOM., UNDET.,
OR -ENDING INVEST. /S-/c1/y/ GATE OF iNAJRY
/NerM. Q,). Yq•) NOUI1 NOW INJURY OCCURRED !£wH.luwrr
brw7 lwMO, I/
202 200. ?Oc M ?OC.
INJURY AT WORK PLACE OF INJURY AIArr. /M~. mrcR J,CAI.7. e//E[, LOCATION
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lSMd/1 J'u w 1121 Wf.. er_ 6,ee1/j/
?Oe 201. ?p,
To b2 CoRIpl2ud M ATTENDING PHYSICIAN 021r To 0. COIRpf212d OY CORONER OdY
212. To IM lM,l 01 IwT [ otcwnA • aM 2M Art w INt c2r12N1 222. Ow AM OMr of ,•21r•II,tIOw 2ndfo. rlwny,t01. w 01, aortal M.t11 O[Orr2A w tlrt twM
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DATE SIGNED /Na. OrY. ,2.1 R OEATN GATE SIGNED
Pf.. Gq. Yar/
HOUR Of DEATH
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72c. M
ONOUNCED DEAD IJIO.. Q17. Yw•1 MONOUNCED DEAD IJIrw)
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~. Good Samaritan Hos - 21 ~ C
WRIAL. CREMATION, DATE NAME OF CEMETERY 011 CREMA
OTHER /SPCCt/jl
2.2. Bnriai ?Zbb. 2 1 k. 9t. Patriahs'
NAME Oi EMMLMER ILIC. No.l
7s. Dale a. Wilson 5252A
FU/,ERAL i1RM AND ADDRESS (STREET NO_I
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iTUR~ ~ DATE PEI
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this to be a true and correct photographic copy
on file with the Cincinnati Board of health.
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cal eglstrar FILED s p .
S L LUCIE Cp E i Y f l A
. CLERlt C RC ~TRAS .
. vERIFrcr,. ;_ .
NCILI ORI/SIN JC/rRICS i L1.07D 611L1K344 PaGE 47`~
CHARTERED
0. 0. BOX 1270, FORT GIERCE• fLOR10A X3454 -TELEPHONE I70S1 46•-0200
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