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Home My WebLink About0722 S1~Q55 ~~ ~ ~ MANATEE COUNTY HEALTH D~€~AitTh~EiVT 202 SIXTN AVENUE. EAST. iRAOEIiTON. 'FLORI~A 335o~-?EIEPHOME 71s-3531 GEOROE M. OAME. M.D.. D~~CCTOR CERTIFtED COPY ~~:•'•~~~' UREAU o~ v~Yw~Nir,urAir,TMamc~ CERT{F{CATE OR DEATH _ F L O R I D A ~w,r~ FIL[ NO. 1~~~2 tet- REG16TRww~~ NO. ,1~(~ orS •1rn (ItRTN AO f ;•~r•~lr ' cooc NO. 2. YiWt ~IpID[MC[l~--w~1~Nfa.1 I!~V4h/NV ~Y~IAYNI~~M~MIW/ ~•~eutel ~•~ACC 0- O[~TN ~. STAi( 6. COuNTY .~~ .,~1 `~ °O""T" ~ianatee /-G'~L I'lorida ~i~ates~ De pl~el~ t. ~S p[S~Gih:f . l n pN~ 0_ CITY. TOwX. O~ IOC~TqN f- 15 -:~CC O~ O[ATN ~ t. CITY. TOMM.OII LOCATION -~eewt ~MS~DE CiTl/ I~M~TS~ ~~;~DL Crtr Li~:rgr ,~, 13i'S(~Cl1t011 .~~: ~O I Palmctto YES~ ~,~, I. N~Y( Of (fJwM iw ~wy~~t. Iw~ NuN ~fben) 1. SS~EET ~oW~[SS -~OS-~T~l O~ ~NST~T~Tp»~(anatce Aicmorial Hos~ital , 4811-Ar1in~Lnn=ltoad a ~~lnrn- __ ~ Y -- - -~- - ] M~Mt o- fi.~t Afi~~tt Lad ~ o~tt Mo~~~ [~n~ Y,~- occcwsco ~ ~r>M «n•~~~ Ra_yraottd C. Cillette ~"TMDe cembe r 1 ~,1968 S S(7[ ~ ~ CO~WI 011 MCE 7 `~ / OATE Of /111TN ?~ J~Gt (I~ ttM1 I K wu~ ~-U- 'J cwU~ U wS MANN~[ N(Y[~M~11~KO^ u ~~7[ 1MI AU/-IfI) ~/i/wHS~ I 4~~w Mwr~ ( Xw. i r r f c• ~t~1C ~ ~~}j~~ w~oow[ot,`7 avc~tEO ~~ ~ ~ ~ ~ p 1~ 1 n) ~ 10~ U~J~I OCC61~TiUM ( Cirr tu/ ~/r Ml I~wt IOD K~MOp' WSMKSSON 1/~OVST~Y IL ~u1iNK~CC f. N~ r/ortMw cN~~tr/1 4 t~h1[~ 0~ w.u-t •-01Wia~- •ltA p~~- ~rn~~~wortyro-ti~~hp.tnwi/rtfiull , _ ••~•~~ Sti~.~ervisor . Power Com~anv Mi~hi~n USA D i~C k 111k ~~, ~A7ME~ S MM( ~ 1•. MO1ME11~S Mb0(N NAME ~ o~ ,,,.,.,~.r Orvillc Gillette J ennie Crill , t6 sou4~ sccw~rr r.o u IN~OIIMANY's ~~a~TUwc ~i~~~~ Palmetto, Florida 364-10-0332 Rev. Fr. Charles B.I~li1~n 4811-Arlin~ton Rd. ,Bav Colon~- 1{ CAUS~ 01 ptATN ~l:+alar ~~fl att u~K I/t11t ~I (• ~SIA~t itL~ JC!ie `~_ I" // ~I IATC~YAl iRillE[h F u n~ r~ 1 L-1'j -^e /f hSET ~MO D[ATN S 1-~ c t0• -A11T l OCATN W~S CAYSEO ~r- // %~ r~ IMMC0IAT[ CAYSE ( - C ` •,.~t faf• ~~~~ cne e~r- u f f e~ t• Co~lui~u. iJ ~~/. py~ TO (11 - -- • 1 tD tAt r~aA /ara nn t~ ) o c• 1 ~t n~K `i). T1-S ~I~~ If~~~~ flt r~ttr- re~istr~t l~i~~ raax f~al. ~[ TO (e) ~- • 1 t 11 A T1 0 ~~T ll. OTlEIt SKIYfKIwf COMp110/~S COwf11t~1l~MC 10 041M ~Ut MOT R(Ul[O 10IIK 1[~MIM4~ OISUSE COMiD111q~ GKII M-MT ~(~7 iy W15 ALTO~SY l~ours ~f- r 1ERfO~~EC~ te~ d~~tA v - lIESO h0 o r e~ tor• ~~~~a.ev- mD. asc~i~ Mow w~u~r occua~co (F:~~r a~u y~ajw~ i~ P~rt /K P~-t Jl ~/it:~ 1/.) ' ••t~~c ••s s AC~~DtbT wK+oc NorK~oc • . ai~~o~f- rr '~ ~ Q tfon •~ v -~ 20e T~wE 0~ J/«~. M~wr~, D~I. Ysa eod~. ~ uuuar ~_ w. . o p. ~. Z 2Gd iNJufiY OCCUA11E0 ~Ot ~iACE O~ Ih1UAr (t_ /. ~A M~O~.f ~Af, 20/. CIT~, TOwM. 0~ IOCAT~ON COUMTY ST~T( Wwt~E AT NOT M'M.IE /~rw. Nd~r~. Mrrtl. s~k~ dII~.. dc.) • A:: St~~• sre to 1• to~p3~t• ` •GCY/~~1• :'.S.t612 a~~•1o6~ w011K ~ AT M011K ~ r.. , ~ ~. .~ t~ / ~ - -^ • '~ ~' 2{ / jltended th~ dae~~s~d /~om J ~~ ~!_CI . t%~1=J '~v ~~nd lut ur A,m •hr~ o~~~~~ i /b%~tM occurred ~t ~n on rA~ d.t• ~r~red •borq: ~nd fo tA~ 6~~t ol in) kno+/~d~s. liom tl~~ c~~ats st~~~d u/s ru-TUwc ~-- ([-.~«<.r tuU, ,,.~ 22b o~I's ' ~'~ rJ ~ 22~•o+~ic s„~c~ ~ .C~~ :. i~ ~~r?~_.~?.L/~' /~1~I,u ; ~.~~,~~'tL%~; ~~~- '/~/,,=~,, j}~ ~u~41. Ufr~T~Ow. i j]b DAT( IJ[ hAME O~ C[MCTEAY QR C1ICMATORY `~}d iOCAT~ph (CKt. l1~oA. N tOL4fyi ~~~~' ~~ /68 Skyway Kem.Gardens ~ Palme ~to ~iar.atee ~~: ida; '~ ~DWIfSS 25. 8~T[ 11EC0. ~Y IIEG u. nJ~ a-N S S~ ATYN[ /~ ~ , ~ ~ 1 ~denton , Fla . lo.~ ~lc'j -~.~ ~ ~ti~~.-,::.v~2o ~r -~1.,- .~t .~1 y~ . -- ~ '~ _ . " ~- ~ J ' . "_ "_ ~ '-.--t~a~ ~ ~ f~~'< ~^!i ~.` ' ~,~`v= ~ - ~ CERTIFIED COPY ~`~r Yt± ^r - .`'._= ~l.~. , . •_ t e _ ~c : S ~ 1~ i ~ ~ ~ :•. .~ : ~~ ~ ! heseby pertify t~i~ v~,~7~e a true and correct copy of the record on file in the Office of the Lo~cE Re'"' ar of Vit ,~toti~tics ot the Manatee County Health Department, 8radenton, Florida. ..; ,. Dpte - . ~~~~ ~ ~•~~~~0 •r ~~ ~ ' - ~til a. . ~ • ~'~ ihJ - ,,~H ,;i~~' ~"`-~' ~ BY~ Manatee County Ith OFficer and Local Registrar Deputy Registrar of Vital Statistics ~g~o e~~ ~ s~~ os ~"`~ ~_~C_v cr`~UCIE CGU`~ Y F A. • ROGER P~~TRAS CLCFK Ct~:CU~ ~ CO'~Rj ~ , • -,.- - . - . `~ - - - ~345 NM~E ?20 ~.