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HomeMy WebLinkAbout2679 f i . } . _ . - _ . . _ ' ~ ! a ~ ~ t~~• ~'TAT~ .o,?~o or Ka~,w ~ ~CERTIFI~AT~ OF [3EATH ' ` ' ~ ~ a , ~1111[J?U O' YIYAL ~'fAYI~'fGO ~ , lYAtR ~Ilt IiO. ~ i , l• ~1 r~~- ' ~ ; .~.p, FLO~IDA ~ j 1 N . ' • ' ~ OIA • HO. i ~r~~~rl~ i eafttll~~ Kl1t~ ~I KAtI~ ~ GOtlt NO. ~ 2. 1tWAl IKSIMIKt(wlw~«+.+~atleMwl Il~w~.+.w: R.ovwwllR~slr4e?.~) ~ ~ ~a~ • f 1 l s STATi . S. COOMTY I ~ ~I~c~1 . !w ~~f- ~~~•.~~'?M,OII tAGA~qM t. ~S ~~C[ W 0[ATN t. CiT~, TOWN,O# IOCA~qN IS RtS~DEMCE A~~~~t INi~DC Ci~Y tINITlY IkS~M CITY ~IMIT3? i ~ r~t~. . • • res? MoO~ ~yi~r~ resj~ no0 ~ ~ 1. 141M( 0/ M1 h?Mt11~1. {~M IbMd ~IMI) r l[MGTN OI fTIKEY ADWC(S1 { HOStITAI OA OM A ~A11M1 1MS~IlUi10M . ST~V 1k IA 11 11 Y[3 ? 1q ~ ~ ° 3 1u~c N FhM ' N ~ Lw OATE ,til~wd Drr Y~v ~ t ' ~ JKhl) - ~ PAt? ~ OUTM : ; i - S[X ~ ~ OOIOR 911 IIACL ~ MAR~lE4 MEYi11 MAl1A1f0? ~T~ Os ~lR1N ~6[ !'~MI • lwOti 1 tWl Y~OI~N IRS. ~ • I~+t NrfL/q) X..w D.w Nan Ya. ' : j M~ t t t• Mq1C N!! 1'O wloowt0 olvowtEO H,g,` 1 16E3 - ~ ':I }l~lil~ IO~.uSU1?lOCtutllTq«lO4Mt(~I~Jrwtfs~N IOQKIIiOCtWi~MEt30A~MOVS111Y 11 ~lRTHKACt{~~f~M~?t~lru~hl) 1 Cfi?tO101~11Mi001M7~t y i •~tA ~~P- Is?f+y'wMtywrUslf~jr,e~r~l)rdhNl ~ ...•.c Car enLer Generai or a ~ ' j I1~~t 111k ~~,,•FAT11[II~S NAM[ ` • ~ I~ MOTYKII S MAtO[M MAME ' ~ ~ j` •F • ' . ) ~n••~i~+? ' Ison Ric r~rdson ~ . .leal ~l~.lit~l:an ~ i ? i~ 1 *A1 O[CfA3(p EVil1 tM U s. ~RNtO ~ORCil1 1 !OClA~ liCU111TY MD. 1) NINRM ~ NYlN4YM4 ~ t~ .1 ~r~.....~~.a....~ ~I/w•Nww.Iw~/..wri ' I JA~lF'S kictiardsan ' ; ~Jp, . : : • .tur,« 1 Av ut4 t~ n e ' ~ ; . 1~. tAYM N!<AfN ~`str Ml1 a~e eMrw'p Ilse M(~l~ (Ql. ~s1 (c).) 1MY[~vAl NYwt[M . . r). f~~~r~l ' ~I~~~t~? ~~MT 1. 0(ATN irA3 C1?~IStD iY~ ~ arscT ~?no ourn t~ ~~kro~~ ~?v~ a~nt~srcr~Iniel~ lie~aorrh~~e- ---1~av ~ r wit' t!i• } . • ' - • , ~ tY~ s•?- ~ . ~ . ~ • utt..e• cl~tks.re..i/.,r, ~ouc ro t?) ~TSe~~~14rQQ1~_.----.._-- • 1 i •tt? tAs yAk~1 ~a~r .I~e I• , - r 1 • • • 'l ~wt cf11~t (~1. . , . i ~ . _ , t r~~l~tsa• Ny}y ni~r DVE TO (a) . T.L_____-! ~ i - ' ~it~f• i~ i,. ~ a r- i~ saaT u. oT~a s+suncun ax~wt~o~4 Caern~rtw ~o ourN Krt ++or rto ta r?~t ~rw~u onusrtaana~ r4 Mat ~ . w ~ ~ M- }41MUitM[Ot . } ~i ~~.tA ~ • ' . ' rts0 MoD ~ i i: •r O~r~1• ~ ib~, ~ ~ ocseRist Noar ~+uu~r otw~~ca ~~oeer..tw~ yW.r~ 1s P~t I M Pwt 1~/ ~t) ..~f.~ ~ ~ciaMt wK~o~ ' ~o~+K~at , : . ; ' _ ! ~f~~~~i- ~ 't = •t tlss •t ~ . . ~ mr TtM[ GI Hw~ AtMll. bq. YNr . ' ~ ~ ~~+~;,~r ' • : ' { ~ . r. . : t . ; ~1 IMiU~Y OtCURRiD ~t. KACE pf 11UU~Y (f. i~ M~As~I Mfrf. ~OJ CITr. TOw91.0~ LUGAi1Q11 OOYMT'/ STA'R ~ wMnt`~T ~~ot wMK.e ~ h~~. ha+?~..r?r.t. N~e+ b(4•. ~te.i• i . j • M~OAK• ' AT !POlIK • i ' • i l ~fN~hd fl?s dwow~+d' /ro+n ~t a ~ ~ . to t ~ a~r /~af aa~ ~ ~ a!!?~ o~ •,QG~aw.-.a~,=~_ ~ ~ DNth occar?+d ~t 6;,~ p- - w~ M fM 1~b st~t~d ~lsr~: ~nr to fM wit o/ ~n~ lnerNd~. /~ow fA~ uvrea ~t~t«/. ' l~ 1 1ta110 M~NAfiMtt (D~rtt M IYk) 720 AD4llESS . ?=t. DATE 31611[0 ~ a . a?• t• ~s i f ...o~.a.. ~Alva U, Urr,H.U. ' Ft. Pierce Fla. Oct. 20- ~~~~P~~~' 23e ~w~, acriTna, ila a?rc . ik MAME 01 CE~tETE6l~ OIl C11EM~T6RY Z3f. IUCAT~D11 tCYf~. f~a1. M ewuf/1 (btW) 1 ~[rov~u sprdpl . ~ ! i ! 1 ~ i , t.',+~~~ j~, ?UMEML OIl 3 SICMRTUR[ AOORESf ~ DATE IItGD. ~Y tOCALRtC. RiGtSTR~l1'SSK TY ~ ; K~~.1~0• ~ , . ,I ; S Pee C1 1 ; ~ • : , ~ ~ ~ ; ~ ; ~~i.iiii~~~~ • . , . • F f i ~ qb this to be a huo and oorrect copy of the Locs! , ; = ~ ~R~g st?'e~'s r~e~c~or~.qn fit$ in the St. Lucie Coun l y, Health D a p e r f. ~ f ` m a n t t F o r 1 P~j~c~., Florida. ~ . 4 , ~ - ~ ! i. ~ ~ ~ d~` f i i t ~va li d un ie:s raiaed ~a! af the St. Lucle + ` ' . M ' .4~ Flealth Department ia af fixed.)' ; • ~ t ; ~ ti. , ~ * = : J a , ' ~ i~ ~ ' . ~ ~ ~ N. D. MIILER, M. D. ~ : . _~`~C. l., R ~ County Meaith Officer b Local Rsgi:trar 1 ' ' • ~ i. ~ ~ , W c ~ ti~~,~~ _ tii A.'!~~ • .i i : ~ ~ ~ i ' { , ' i~ . ~ , ~_~_„~.~ti~ i ~ ~ ~ ~ , + 1 ~ i . ~~y~;:~.s; • p~,ry lo~.al Reqht'rar `w`.Y.+6" ~ ` , ~ j i( ,t ~ • . ~ ~ ~~r"'s ? . ! . .r . ~ . - . 1 ! r ~ ~ . ~ ~ ~ 1 - ' . . ~ ~ . + ~ ~ I + ~ • e ' ~ ~j • ~ ' . . • . . ; f ; ' t, ] ~ ~ . : 1 ' ~ E t --3- - - - - • i~ 1 l__ t ~ . _ ~1, ~ ! 132Q4~3 ~ ~ ~ t ~ ~ fi~EO AND RECO DED • r ' ' e~~ D00 ~ !N K . ~ i ~ J~ k-~ ~ 1964 DEC 30 PM 1: 5S ~ . ~'r'' . , ty : • , ' ROGER POiTi~~+S, CtERK ' ,t° ; ~ ~'•:ti ~ : St. LUC(E COU~~IY, FLQRIOA ; : ~ ~p~l~~*~ - r % t ~ . - ~ . ~ . ~ L' ~.7~ -~..~;t ~ ~ • . i ti ~ t d E ~ ~ ~~f~~ ~ . . . . _ , . • I. . - . t . - .J • ' ~t. .1`~,# . • ~ ~ ~ ' O:R~ , t i ~ ' ~ - ~ Q7 r~Ac.c 273 ~ ' .800K