The URL can be used to link to this page

Home My WebLink About0208 . . ~ ~ , ' • ~ ~ ' ' ` .L~O~~~ ~ . ' • ~ ~ i ~ r•---- ..--r i , T,.~ ~ i _ i.._-_ •---4 ~ , , . . . . ~ CANA1. ZONE G-~t?li~RNMENT _ . - . ~ - \ ~ ~ ~ C~RTIF'ICATE OF' DEATM ~uc No.._..------- ; ~ IN cA~vA~ zoN~ ~ 4 et~~cs oF nar?~x s. ~ ~ ~~rc~ to +a~a ~ ~m.t) ~ ; a TOtvN 4R PI.A ~ ~~~°~A~~ ~ At ~tA 1.~r.~'j !0. ~ a`~~ ~ - s~PIT~ (u xo~ ~x«~w. ~+~.aa~.,~a w~) crryr u~~~ ~vvg ~a`•~ ~uxw) ~ i ~.9. 5iuiYA ~C 1~ iA ti _ , i.&NiUTH OF TIM6 ON IBTIIMUB a NQ~ ~(u ~1.1~ bation) ' . (y~) (ldoat~) (~7') r.. ~aiTRAL AYt~ ~ NAME OF DECFJ?SFD 4. DATB OF ABA7'S ? . rtyp.ar~c) _ t;Eq~ MII.~.~ . ~ ~~~t~to~~. 6. 881C 6. OOLOA OR 7. ]dARRIBD. BINUL$ 8. DATS OF 9. dti8 (is~ IF UNDBR l YR. IF UNDBR !1 H~'t8. °s : CED ($p~tr) IYORr BI~iTB Irt bitbdt ) 1[octb Dq~ Ho~ ~ 1~in. 1 ~ ~ oA~, t~?~~i. • ldr. U~;~.L OC)CUPATIOPI lOb. ffiKD OF BDSINF88 OR INUD9TRY (it ~mplo~ ot Pa~- ti~.. mim Qm~el Uoatpan7 9e (7~aa1 Zoa Oo~ern~oR a~ aod ~in ~ '~ARTRI~LR ~~R11~'R~ I~~ ~r T1j~Sion and Id~~i6atlc~ numbw) : i ' • ~ 1!. GTI'I7.SN8~iIP ; 11. BIRTHPI.ACS (8tst~ ar lae~el~n aoomt+7) { ~ ~r ~ ~iY'i.Al~ ~ t3. FATHSF~'S NAME 11a. MOTF~R'8 ~[AIDEN NA~dB 1lb. 8POD8$"8 NAMB . ~ I I al~~R 1iD1 K1~IM ia scx,x;tAr. s~cuRrrY oa w~rt ~ 0 15. WAS TH8 D~D RVLR IN 0. 8. ARMED FQRCFSt TIItICA1'ION Na. ~ ~ ' ar na- ~ 7'~ t~*+ vsr ce dsir d Nniet) A I 0~6 t~ 00~9 : ~ 086 _ ' ~ nvFO~rrr c~+ a~ itb. anna~e ~ ~ : i ~4 SAtfl'~1 C~C tA ; ~ ~ ~ta .s srtt . . 18 CA[18g oe DgATH TIME BETWEEN OODE , 6skt ooly ow oww ~ ON8ET ~ DEATH ~ : ~j per 1ia~ tor (s)~ (b)~ D1B8ASR QIt OOt~3DTCI0i~i r,~ }~'~'Q~~ ' c7 ~ ~ad (e) D[RECTLY LSADIN(i'C~0 DB~1TH• ~ ~ •(Qiv~ d~ne, tnj~r ~'~i,`EpLNT CAt18~ DDE ~ - : rir~ 1o TO (b)~~~i~~~i_. , cr oomP&+tbn wh~ Morbid eao~t3aa~ Y~a;. {#r~t w~ tb~ IMMEDIA'rS ~ ~bo» au~N ~ ~ ~7' - _ w CAUSE d destb. not ~ ~ ~t D~ ~ ~i , - . 'z t~3`rs'd~ephyiia'et~o~) tC3THffitSI(1t1IFICANT(70NDTTIONB ~C~--------------------•--•--- tioo~ oontributin~ to t~ d~aR6 bqt ~ ~•,;M• tbnd? not rod~ted to tb~ diw~w ar eoo~F3ou i . r,,. 3 ; ` I , ~ y ~ ~ ~ E~ ' • ' !0. AUTOPBYt 7 • t9.r.DA7'8 OF OPER- 1Qh. MAJOR PiNDIN(iIB OF OPEEtATION ~ a N~ ~ S~; .~V ~ f =A't'}ON ~ ~r - . ~ ~ ti fK : r V : S w PUt~ ~~c s AOCIDENT (8P~1) =Ib. Pi,ACB OF IN~Y ar 71~. (f~b or tv+r~) (~lr~) i r- ; -SUICIBR ~bout homq ~x~, ta~o~7~ ~+~R ~ ~ v'~~ f'' • • m y~ • ,AOldICIDS ~ w ~ . o . z =ld. TIME (~orm) (Da7) (YM*) (H*•) =1~. INJIIRY OCQJRBRD l~t. SOII DID IIi3iJRY OOCt3~4 ~ o~'`c N OF a, R~ark~ p at ~rork O` ~ ~ ~ 4 W INNRY ~ ' _ ` . 1l..... Wl I dat aw W~wi ~ ' ~ ~ " S2. J ~ ~`~~M.! 1 iw~rd fM irew~d/nw . ll----- M . . ~ ~ w . ~ ~~•~S~lt..._...~ 1l-----. aJ Wt JNA ~oa~ned .~~-~ssY,,JYrw ~t asw s~ M W Jrlt ~ sM~. o ?d~. SICiNA'fUR$ ( D~ p w a r ~ i W) I~. ADDRF8`J s K~ l i~ I 9ae. DA ~ H[(iN~D ~ . ,Q ~ t~~T~p Q. CH/C~t10. ~t~l.ttlQl 4•~+ 9d B n- ~ w~ f4a. BUR~~ A't ~ON~ 3~. BATS ~0' N~TOAY~Y OR 9sd. 1ACllTION (C~j ar b~~~'~ . RF•M (8v«~T ~ ^ = u DATE RF,CBIVSU HY VI• BI~NATUElS OF V1TAL BTATI8TIC8 (~RS s5. FUN$RAL D~ ADDRFAB ` T~r, sTe~srice tr~rr f~AX ~f. F~K~Y, iaQ~iGAS 11~SP iT~lt. . a~ ~ - --.....y`~C~~1' C~j; - - :.~e`~~~D~1 ~ , r'.,~~~ . f_ f~ fi~(~ ~ G ~ ~~~1` . ~ ~IG`~ ~ : :~l ~i~„+.J ` to •Ov,'~,+•` F ~,~7 ~~l7'3L~~ . ~ ? , . . ' ' - ~ ~ ~ j : ti1 _ ~It_. • /-•R~c~rd-3G~K ~ H: : t i ; ~ ~S'~ :r: ~ ~ ' ~ : i ~.-r, . ` r ::l '~f4 1964 fd0~l 16 PM 3: 4S ~ ; ' :,t:r~ . i . ~ ~ ' ~ , • A. ~ F. `o ~ ~ ROGCR PDITitAS, c~r~K~ ~ . '•`~'~,•,,ro~ ~T"~;~~~,•~:r. .R, ~ ST. IUCI~ COUNTY, FIORiDA ~ ! . ~a~x ~.43 ~ACE203 : . . . .