Loading...
HomeMy WebLinkAbout0446~ :~~~ e~- KAT[ so~D oR NG~111 CERTI~ICATE OF DEATH ~. ~ cc~es a ~UA[AU OF VITAL fTATIfTICf RA?t RIL[ NO. ~•~•~ *«- rd •Atw 5~.(~91,FLOAIDA • b2 ~ NO. BIRTM NA. _ REOItTRAR rop~rlj •~~lYlld 1~lAt[ 01 O~ATN GODt NO. 2. YNIT ~ NOtNt[(II~w~Isir~tAw~ l~Mrwwi.~~ R~~MrN/n~iwiriw) and •11; • COuYTY ,t~~ClC ba(~2S Florida .7ti• 1.~1C~C :• ~laetd ~ r, y~r- - ~. L~tr towh.0~ IOtATqN c. K~LAtE Oi DE~TM s. t~tr. TO~MN.OR IOCATqN e. K RES~OtNCE ^~ne~t .'12e. ~NS~OE ~~ UrITS1 iNS~DE CITY Llrng+ Ft,• ~'ICPCC rE5 No^ F'"~.~~'1CI'CC rESI~ No(~__ f. h-vf ~~ /~ wN i~ ~NyYd. /~et drttt ~dfru~l 1 STIIEET AOOItE55 MOS-~ ~ ~ l OA ~ ~yS*~`-*~ FL. t'ierce I•,em. i~:~: p. l21 'Il~.mbli~~:~ tlinp. kd. . ------- tiq/ Viq(e L~at ~ DATE al~wN Dq Yta ) NAM[ O~ o~c~.•~o ... ~ ~ , :-!~ °i 'r'ebruary 3, 1yb~ 'ly/.I r,r prl~ll : Y~.a "y~~ V• It1.Y~! •~• OEATN S S(7t 6 cao~ o~ ~~cc ~~ YAAA~D ^ MEY[R MMAKO^ •~fE OF ~IIITM ~ AGE (lw /WI ~ U~~ 1 n~ {IIi0I11~ NK i' ~ ~~b ~ ~~ ~~~) YwtM l •: ' I ~ ~ ~ D~w Nwn ~afi+ • f t• • -7 + dV011tED 7 ~ NIDOiM[0 .~ p I a~ n l~ 10~ ~.S~~t :~CCU~ATqN ~Gwe ti~1 ~/rWt p~t IOG KINOOf WSINESSOU 1MOUST~Y 11 WTNIIACE (9~fe M~i-ey~ pY~t-/) 12 qTREl10i ~NT ~UMIRtI +lth y~r- ~rn.~ AoNyrwli~fhN.ttt*~/r~tudl • ~•~•~~ 'rar~.er ~y~1 l~aru~ Jefferso~-ville, Ir-d• US11 el~ct Ink ~j f~tM[R S h~Mt 1~ MOTI~R'S MAIOEN MAME er '~p~'r~«~ f:CT1[^_~ f.1TIP i~8C1C~( ~'C1'Xl.1S !S »~S CKF~StO E~~R ~N U i A~MEO iORt[9 1~ SOC1~L SEC~R~ir Np. 17 n~nwMiwrs aow~Tw~s 1.~,5 ~lt~ . _ /~~ I N Y Y.M V A1 ` .I / M~. ~.N ~V ~ rY~ ~I MH~f1~ ~C~Y/iI ,.o I ivone ~~~~~• ~t.l'lerce. FI02`1dA Yun~ r~ 1 :e C~U~C 01 O[ATN ~F.'~ftr o~l/ ~~t t~ra per (~~e ~i- 1~). fAl. a~~ lc).) INiEIIVAL ~EirfEEN :lr~eto- F aqt ~ p(~TN Y1l15 U45E0 ~Y 01lSET A~If~A OEAT~ tVY(OIAT[ tAUSt p1 ~t~~C~'Cr~~ill }SC1~Q~']~:~j~C all. L7~G;Z-_, _ _ ~J~t [IIe . _..._ _ _ _ _ '___' _ ___ . :n• eet- tlflt~t• ~•.,,~~~~y,;f..,, p„E ,o ~e, ' ___._ h,rt,eriosclero:~is • 1 tH ll~! _ r S4- /~It /~ [O . - _ _ ._ _ '_ ~ ~) . p ~ • I • rRt~lr~r t ,l• [~Y!/ . ~::~n~ l~t r~It~- OI:E i0 (t)-- ---- -_ ::~••~ ara ful . ~ a e f n T~ t •~ ` ~ oa r T u OtHU Su~urK~wr Ca.wtqr.s Camtuu~K to Out» ~ur ~Or ntut[o r0 rwE Tr~rrY~ Ois[~s[ Capt~ON GNEw M ~uit 1(a) t~. W~5 AUfOI51/ .JUt F -ERiOQME01 ~ at ,tea[A ~ rE5^ MO~. r ~ef.-re •ellnS •n~ -- - -- --- --- --- -------- --- ----- " 20~ f- :~W/ 26'. WS(11t~! NpNr ~M1U11~OtCu1111tU (F'wfrr wdrrr~/~wjrr~i~ %~rt /M Ptlf I/~/MtA N.l ~ a Y i S b I ~C~[4 t; :(A LK~ I NO ~p~al- u i I ^ O ~ ,~ Or ~~1J. _ __'__ J~_" 31r : ~~~ ..r Noc. ~f~w-. Iqr. Yro - - - - - - - - - --- - --- - ----- - ---- ---- - - - ~ ~ ,~i ~. •. n~ . c p + ~ . y - ~~ - --- ---- °_ --- I~~~ »r ett~a~en :lkii~~~ ~,r inn~~r ~• /. u o. ar+wl ~..iv. 20/ C~iY. iOwN ~M I~KAIiIM rnuMTr st~tt MFy~ ., ~~ w,~i r.u~- U ~+~~w. ~..n~•~. rrnr. «~~~ ir~~ .~!: ~ , 1vJM• At ALFP ~)~i . tu ~~.'L'a__j~ ^ ~v~ ~nJf~~ta~~ ~,~ ~Iir~on ~'LIL~~~ss_ 2~ l~t~end~dtA~dec~~~~dliom Vi~~~ rU ~ D~~tA uccurred ~f _ _~~:~_ Y~ . m on tM d~t~ ~t~f~d ~bor~. ~nd to tM M~! o/ m) lno~hd/~. /ioqt fA~ e~uN~ ~bt~O l 1 1 1ll~• - _- 2~~ •IGNATYR[ (IN/Ifl M fWf~ ?IA ADOR[SS ?1t. DATE S16l~EO +r+ to te ~ -.•-~•« • /+lv~ U. ~rr~t~..u. h't.i'ierce, F'la. 2-10-bb p ."°r•~~. il. w.,.. cn~u~ar 2l~ a-tt 23t MAMEOit[MEft119011C11EY~TOIIr 2]~ ~ou1~~Cir~.t.s~~.rrw~rp (St~te) ~Y.~i1~. I1J~fl~n~ (d~s. Ft.:'ieree, Florida _~uri~l 2-5-bci Fiillcrest t•.ein ~ _ . :. J.~ g I Y j~ f;;w( P~i DtR(~10R 5 SIGNAT4RE ~y',' A~ESSlth. J~, ~ 2S OATE RECD. ~Y IOCAL ~EG I~. REGKTR~R'S SIGNATYRE /~ ~ '••.`'''e ~.il+oa .. ?airu t~t.rierce,Fln. ~-11-65 ,,nna l•ee i~e:-i..on, a.r. ~ slo~9i ~ . 19~0 D~~ I 7 Pk ~ 32 ~ ~ f tLCd t~ f FrC~Q ~ f 0 Sf.IUCtF CQIIN; ~ R~GER POITRA S A. t d correct copy o ~ + rwr~b~- prtMy thb to bs e tru~ an me ux+• CLERK CL~CUST COttR 1 Rplatrarf r+soord on fitt in the St. luc~e County Health nepa.t ~. ,.~, r~ n~•r~~ m~rrt ~f ~ ~~~., foA Pi~u. Florlde. (Wun{rp~ Nof vslid unless r~isscl seal ai the ~t. luu~ , i ~ welth D~pittment ~s atfixe.i.) ~~ ; ~ . . ~.~ ' V ~ ~ ,~' , ~ ~T ' N. ~. MILLER. M. D. ~ yv . ' Countr Health Officsr 6 La~l Reqistre~ ; . ,W - p~ .~ ~ , . -~ / 6~~ ~ a.~.~-~ ~'- r ~~J ce~', ~,.~~ , :~ - . ~ ~ ~Y ~pC~I ~dl~f-AI ' i . i . ~ . S ~ i aoa°'~c~5 PscE ~4'~ . ~ - -_ . ._ - .~ ~~~ _.r ~ . ~ ==~~. ~s~~