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Home My WebLink About2623 ~3~oi~ ~ ~ . a . ; ~ _ . . . . _ ~ , _ . ; A~; ~ / s ~ . i ' ~ ; } rT~r~ ~ci~~ or Wrr?i..M ~~:R71~ICA'1'E DEA'TW ; ~ ~ . du~w?~ t~? vir~u. ~r~r~c~ ' rr~Y~ n~~t ao. , Y.O l~ I D J~l -~-_y ; r ~ a ~ Na s~p~?l: ~ PO.A6f iI r~tATM Gb03 NO. YwA~ 11ts~~t (w~+.M...ah..~ Il~..~.w.w •~rwr. .a.sn4.l a~e~J ~•e STAT[ couytr • I ! l COUMTY • • ~ • y~te~~ ~ ~~a L~n~ ! A . CIiY. ~ O' t M.O~ IOCATiOM t. IUC[ Ot 0[ATM t L1TY. TOMN.OII IACAT10a1 t. H Ri3lDlMC[ ~ iN41D[ CITY IIMITf! IM110t CITY (IM11S~ l Y[f NO ~ ll~. • ~ • ~ Y[f Iq f, ~TU b~ FbY"L~ ~~C~~r wMt d a+) • ltMOiN Ot STR[[T A0011(SS ~ o+~ r~~M~ ~sn~ulw« st~r w~ u tcs~ eto - ; s'~s~ wN. t«r e a c~ t~.,w ~q Y.a? ~ t; 1~s. rw) j ; o u~ t N ' i~ ~ , • fiA COl9A OA MU ~ YRA~KD N[Y[11 MA11111[0 ~ OAT[ 01 ~IRTN ~ AG[ 1"fir~ 11 {l~Mt~ 1 fWl 1/~OUII{ ~ ~ !wt OMiAfq1 NwY~ O+w Nwn YM 2 ~ t s Femals w'h t w~oo~rca avo~cEO 1 ~ ~1~1~~~ 1 yftiK OCCYIA ~OM IOYr H~iNKK! IIMIDOf lV11MlSS01~ WOVSTIIY 11 ~IIITIIIIACE (Z'~ff N~ff~ ffYUt/1 C111iO10~ ~MT 001NfA~1 a_ # ~~1a f..hy.ary~«livh~..~.+.~~, a) M p p ~ : i ~1~~~ tst ,~~?~~Hot~ ew ife ~ TN(Il'f MA!Ot1111Ak[ j 1~• • ~rr•+•~ irat e a ai gb e o e P ` i~ t ws~ aa~ o vc N u ~~ace rouocsi !OC ![CU~~Tr MO 1) o M~w?r~~a , ~ Thocoas C, Brew ~ ' i r ~r.......,.~e....~ w.».«........»,r..a.a ~ ~ ~ ~ A/iw~' : i • ~ l i s~wa rsntw (i~u+..Jr nw p. t.). to). tr~.) ~Krcev~ ~rrccN ~{u~•. jt , arsa a+o ourM , ' • •y•t•~ii• ?AIITA o[Aw11~ONCTntAUf~ (a) ~t~sc~~~.~~[1 ~LY$Z°~Q@--.-- - . i+ ' ~ ~`1 ~~t• • ! - •1i1~e`t\• v~Jd ~j,w 1 w~. pR TO - - . ~8w a~at ~ ' ' 1 • . . 1 . ` ~ , rra~+.i nw ..b~. OIi[ TO lN rl~f~/r~~ - - 'i ~ ; ' ~~i~fi 1• l~~taw l~l. '_"`T--- ~~T u. at~ s+s~cain ow~atio~ qora~rwRrw ro ourn ~?r Not ~uo ro Twt ~t~c~r?t oix~?x t~aatw~ ~ w?ret ~(e) AU ~ ~ ' i rN ~t- ~ r[Rf011MtG1 ( ~ ? , t t ~i~tw ~ YES MO ~~f~ra ~ •art•~ •~f a?aioc~T suKw[ MouK1a otscewc wo+r iM~u~racu#wco (dl~t~?w~hrt yuJur~ is Pr!!~r Pu~ Il yY~ 1/.1 } - i ~ • ~ ? 1 l~• •t T~r[ ii~wr 111rwM. Del. Y~r i~ ~ r•~~• MUVRY A. M. . ~ . { I , tKwRr Octu~co mr. K~CE W quu~r.A. h r+ ~t Mr~ 6IT~. TOM~iI. 011 LOCAipp1 cOUMTII fTAT[ ~ 1 w~~?c ~ wr wwai ~ M¦. /.a.+~..r.Mr. +I~nr bty., ua) ~ i NOi1R AT ~i1K ~ } ; ; i 2i l~f teAd~ fM J~o~swl /ron~ . lo ~n/ luf w~ ~ allre en ~ n/~ /6a i~ ~ Aiar -"'~'T"T ! i ` D~afA ~ol~rril ~f _ • - a~ an tM I~fs ~t~trd ~lo~~: ~M to tA~ b~af o/ mf 1~+p#hdh. fro~n 1A~ b~ww ~f~ts~. i ~ . ?~1 ~tfis MiiMtWli (IArrrttql6A) tl'a ADOp[SS 1L. DAi[iKMEO ~ i ' • • t! Y• ' ~ •t•~~~~• a Dav d L Ro~r~ N D - ~ 8 N e ~ • irt ~t~. ~k ~~yTqM. 2~ pATE MAME d C[w[T[R~ 04 C~EMATORY 2~i LOCATION (C~i1. (a?~• M t~Yilt/) ~~~1~ ~ ` Rt~Wn~t (8yst~1 ~ ; 1 I ' i ~ ~~1~ p~ fU1K1U?L Si~iMATUR at~d`0O1Ftbneral Haae, ~~rE RfCO. ~Y ~OSAI REa. ~E TMI! SKoNA Y11E ~ ~ d...,~~• oee h W Ya e - ' ~t ; • ~ 1~~e~~oertlfy~'ti~is b b~ a tru~ ar~d oornKt oopy of tFM Locai ; E - ~~,~~is l r~r~ 4 q~ c r d or~ file !n the St. lucle Gounty Healtfi Depsrt- ~~r~~~ 'rt ~Fe~, florid~. ~ ; ; 4, ~ • _ . ~ , ; '=L~ `'~='~'(VYar~~q$:•flot veltd unleu raiaed see) of tfie St. tucia ~ ' ~Cq~r ty: Healih D~partmen`t i: affixed.j " : :,l; : , i ,'~`1.~h~ f r : ~ ~ i 1~'jt } } ~'i _'f;` a?tCi ~ • i : i~ '=y:rv' !:'l P!. U. MItIER, M. Q. , , • ? ~ ~ ; _ ~ l t: ~ ~ ~ 1 ~ ~ ~ County HeaNh Offker ~ local R isftar . ~ : : . ~f ~ > > ' , " . ~ % ~~i~~ tw ~ 1 r. - 1 ~ : ~ ~ i.i i.•~~~ i ' p,~tr Deputy t~cal Re~istnr ~ C3 ~r•. , . ~f : . • ~ ` . . ~ - 1~ r i ~ , . . _ _ _ . - - - - - - . ~ - - _ . . _ _ - i `t~ . - , ~ ~ ~ - ~3,`Z01~3 : . - ; ~ F , AND RECOR i' ' ~ ~ ~ ~ DED . . ~ ~ . N cia DOOK ~ . . ~ ; - ~ 1964 DEC 30 AM 10: 33 , ~ 1 x ` ' . - E E ~ o ROGER POITRAS CLERK ~ : ~ W., . S1. LUCiE COUN11', FLORIDA . ' : * ~~,-~.}fC~~:- ~ - . ~ . . v .sr ~ ~~~~j ' - ~ ; ! ~ .,r - . - - ~ _ _ : ....<< ~ . . ~pRK ~.o~r ~A~F22z ~ . ~ ~ ~ - . ~ . - - 3 , .