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HomeMy WebLinkAbout0964slss~o Stat~ of Florida CERTIFICATE OF DEATH Deparl~aeot ot Htalth ~t-d Rehabilitative Services V1TAL STATISTICS F L O R I D A f vPE OR PRINT IN PERMANENT BLACK INK ~ I~~l~ ~, ~,~.i q.e...r. •»rn ace.~• •10 Y qaM OCCU~N~ ra ~,~„w~,.. 4~. ~lf~O~wCE N~ON .owff.o.. ~ ~ ~ ~ M ~ ~ ~ a ~ a ~ 7 ~ -~ ~ .~ J ~ . ' 1~ . ~.w - ~-~~ lTATt /ILt NO.~~__ ..~_^- REG16?pwp 3 NQ C~ASEG-N4ME ~a• ~yw~ ~~1~ SlY OAIE W O~AIM ~ rtw•w, ~~~, •tu ~ , ;umuel Coldberg : Male , Noverober ?0, 1977 uee ...~n. .~o.,~ .u.K.~ ~.,,::~ - .~c - ~:,~ -- ~. , .f,._ ~.~.. ~ ... -- c.ie a i~.i-+ :~..:::-..:. cow+~. a a.~N n.e.. ..~.~f ~ ..oi w.~ wun ... •e.. ~ ~ s.uN.. ~~e Jul 1~ ] C~0 ~. Srowasd White ~ ~ ~ ~ ,. ~ _ - --- - ~~f~W (~ ~~~f NOS/IIAI ~ OTMI~ NStITV110N-N ~N we~ ~.. ~~r.~~ ~~vs ~w~. •.w ..w~•~ . U1r. TQ11Vfi. W IOCAl1ON O1 OEA1M : :.. . .:. ... .... ~. Ho1lyWOOd Nedical Ceater _ _ _ ___ ,. ~Yes h Hollyaood ' -' _'_ ' _ _ STAIE Of W1M ~~~ Mo~ w ~ 1~,~~~~ CITI2EN d wMAI C01MT~1/ MA~MtD. ~+E~Et w-tbt0. lSutvtv~K, 5~01lSE • w r~~i. an~ u~a•~ •~~a ~ i WvOJ~Ct ~vecMrl IAura L~vy N~I~arr~c~ ~~~ S A Ruasia ~a••n•, • U _ ---- _ . . . ~ -~---- - - USUAI OCCU-ATi0r1 .av~ iw.o o~ ~.o~~ ~ ow~~.c ros~ o. tIND W WSMESS O~ ~WUSTt~ SOCIwI StCUl111I NUWE~ ..~ - •OY~G ~W. MM p N~~~p ~ ~xti i ~ T „' ~~ oe6-otiaeiq-~ ~~. For~n --- - _ --- -- ____ _____- RESWENCE-S1~/E COUr+tr Mr. ~Ov+~+. OR tOCwtqN ~M~ c.+. .~m l~~Eli ~nO -ap+~t~ ~ ~f.~tw..~s w ro Y~s 14 5j00 W~sh. St. ~M101 . Holly~ro~d BrovRrd Florida , , ,w ,,. ,,. ~wtHEt-N,wE nn~ +.oa~ ..s~ MOTI~f-MA10(NN4ME ~ati~ ..na~ .•~+ „ Unob. ,~ Unob. ~ Iti~ORMANI-WAME wu\NG AOO~ESS ~s~nn o~ ~~e w. un w.o.... t~u~. tr~ „~ Laura Coldberg ~,. 53'~ Wesh. SL. ~-:~[101 Hlwd., Fla. 33~21 -AfT I OEAM WAS CA113ED ~T ~[N/Ef ~W(-' OI~ C4USI -[~ 1~1E ~O~ (e). fe-. ~ l~)~ .r/ ^..u~ IM NMIIM OMM~ ~M M• ~ ~r.rwp c~u ~ /01 ~ C ~ ~,,,,k,~, - ha~.c ~Ln l ~•- . M ' corw~o^f. u•.n. (.~ ~:tL~ ~ C(..LY..iN' ~ N'~~ /W~ ~~ ~. r ir~G _1_~L~y~=!r_ ~w~~w O~~f ~~l~ q ~-I ~r~~0utf C~Yf~ ~N. nf i COMf10MK~ Or M q, p M •1U1M0 t~~ YM~fti ~ ~ ~t~N~ C~YM 1~1t ~/,~~, /~ / f ~ . ' ~L~ - a~ U~ '~ ~ `' a _ l~~ yf~k tet4'/ C(.1:tek.ee~Gl'7~, ~C ((~C 7t ~ ~4 t _ ,,,~_ ~A~i M OTME~ SIG+iMKANT [p+0 eo•~~o+s co.ow~m..~ a w.w~ w~ ..o~ au.i~ .o c.~~~ eM. «.u. .,e~ ~«S~ r rES ~e~e IM~~MG1 CC ' ~ ~ ~` ~ l ~lf M +O~ Ll~~l~ ~M Nt~~~uMwG C~. ~~ ~. - ,.. No ,w No vt ~ Gt1. ~I~t~t ~t ~ •-J o. e~.~.~ ~O~~ ~/[W~ A ~ rO~iw. r~. ~1~~~ qp iNIUR~ OCCUUEO ~ IMt~~ .uNN W~~aw~~ n~ ~~p ~ O~ ~tlt o, e~r ~~ ~ ~ OE ~QA : K~ ~+M }M 7R M IM IN~Mr A1 WOfR RACE Oi N11A11 ~t wow. r.~~. fnlfr. ~~C~W~. IOCApON . . fnit~ o~ ~ r• .ao , t~n O~ ~O.w, sr~q ~ ~ snun ni a»o~ OMK~ MOG. ~t ~fMCN~ 1 ~ . 7M ~ CEf~~fKAf~OH- ..wrw w• nu ~ ~a+••. w. ~w~SKUw ~ J ~[- ~ ~n1..Me r«~ 1~r~'`t_~) ~ / ~ [~iN f/pV'~WM1 dV I~ ZI~ OtC~•t!Q ~Mr ~~ C V~7 1 c[RiN~u-r~a+=MEO~C~I c:wwwE~ oi c-E~ o•• •...:v o.~ ~urr~~npr O~ wq ~00~ ~.a~w rw .n~1+~c~.p.., .w r~ www0~•. a~M p(CVf~lOOw Mf O~M ~MO OYf ~O M1M UY1~~S/ saae m - CERTIiI~t-IJAME ~nH W -~wn ~ -~' --- -_~-_~~SM ~~u ~~~•o w• v•~w.~~.~ w. ~• oo~ov w. ..~~ va~•w cn~v.•ao a. ..~ .~c~. a.. ~-• ~~~ qu ~OO~ ~rh~ Yf~M ~rOV~~ O~H. ~.i0. ~O M ~~ Oi ~~ ~rqw~lOGf, t ~ ~• ,,. ! % l' ~- ,~~ .~' ~v ~ ~~. 3 : 00~ .o ... ~.,,~.,., ~.._, ~W d q~ti ~~~ OKfq).~ w~f ~~WO~MC~O D~~O .Or~ s.. •:.• row tl. li,~ ~?~~.~e ~tSll_~-Lf _ ~ v'jjY~[7 ~ y. • wul wOO~ESS- E r ~- 's ~~ o... ~~ ~L D ' ~1KIAl. CREMATIOr+. ~fr~Ov l EMETE+~I O~ C~EMAT t-w~+ME ....~~, ~ ,N Buriel ,„ I~etl-El Cemetery ~r DAIE ~ i..W+», N~. •l~~~ ~UNER~1 HOMI-NAM( ~ND Ip(I1(SS _ ,.. Nov. 21, 1977 _ „jt ivers ide Mem. Cha~ ~ S. Ji612 ~ur+E~~l~ ~~r.~ t~% .e! f l~ Rev.7176 so M 7~ ~ _ _ ~ _/' ~ a~~ e o~ •~q~-- --i OnTE --p ~ '"s, o.~. r1.r _ ~~k~K•-f l!~_ .~ 1 ~a ~`/.~O / `l~-. __~ `~~°'~0 3 3o Y ~'..q ~,. ~?~~''~oc.T~a. ~... o. b_.. ~ .,.,. ~,., Fort I.auderdale~ Florida _ _, 16480~NE 19t1 Ave. N.Miami Bch., t lorida et, ~ , o.r~ nc~weo s. s«.~ o~s~..e„ 7t ~cfi: -_~c ~ ~ i: ~"-, . ! ~.. ~~- . - . ~~ . -~`%; f ~~ ~ ~ w~- ' p~~! ~ . ~ • • . . . . ~ - ' ~ . ~ ~ . ~ • .~ _ • ~ •~ ~ :~. . . + " . ' . . .~ _ ccK-ri ~i e~ co~~i I hereby rtify the above to be a true and correct cepy o~ ti~e I.ocal Registrar's '~~l~n the Broward County liealth Department at Fort I.auderdale, Florida. , reco ~ q'. r{ ~ _ i- '"Y.f ( in~~C~:~Va~nless taised seal of the Broward County ilealth llepi. is affixed.) , ..- ;! `~ ~ j~ ~ f~ 1~`' r i~ _t. G~~{j~'~"J%f_ ~G ~. %~T,~> f:.~.l i~ . ~.'. , ~ . - ~ ~~~~~~~. ~E~1 County llealth Oft'icer and Local Registrar ~~- i:! :*It 'f_' ;~:~ : • . _ - ,~ ~ . 1 • ,~i~~.;. ;~ c~•~~~ ' ' `A, ~/i~ .l~,~ l r! 1 _ ~! .:f1 ~ , --~C_ ~. Chief i~puty Local Regi rar - , - -- - -- ----- ~, - : . . _ •., f. • . ,'r ~ . ' i•:• .:.,' ~"~'•~Y ~,.t~!+~~1. . . ~Z, , ~; . . ~~ ~ ~ . 51y~~f) 1981 NAR 1 I P!; 1= 25 F~~cr ~r+r «cukr.t o S RCGER PO:TRAS, ClEnh CtPCU11 CCU. _~.. . .~• - ',~,~r `iK ~~~ Q~UE ~~'~ t s ~ ~ ~a"~-5=.~,i _ -- ..._ _ _ . . .. ' . " . _ ~ ~'=~~:. . ._ . .. ' ... _ _ s