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HomeMy WebLinkAbout2889 ~ , ~ ~r ~ : ' ` ~„Y~ ~o~p. ~ N~,TM CERTI~ICATF. OF D~ATH ~ - OURtAU Or VlTAL ~'TAri~'11C~ fTATR rlLt ''0. ~ FI.ORIDA ~ A , ~ t: ' ~ e i Y H . t. usus~ R~aotNCScA1~.~•r••+r:.d. uw+:w~l,..: a..wb.w...+,~..b.) ~ ~ ' 1. I'LIISi 0/ OiATN CODt NO. STAT[ COUNTY ~ t f. C? NTY ~ / ; ; • 0, ~TY, TOWN.O~ IAtAT10M A n?LRCE Of OEATM A CITY, TOWM, OR LOCATqN t. tS REi10[MCE ~ IMSIDE CIIY LIMITSI tNi10( CITY IIMI 1 3~ ~ Y[S MOO Y[S~ MO ~ i d. MAME 0/ not M ~NDitd, fiof ihNf eltfcN) ILMGtH Oi t. STREET ADDNESS pil A?AJtllt ! M4S11TAl OQ STAY IN 10 YES ? MO ~ j INSTITUTqII ~ ; Dl1TE ~I~+1 D+1 Yfo l/AMi 0o EYIIi A/lult Z~ Of ~ ~[C[AKY DUTM b ,Z ; (7tiy+ M F~la~) : . S[X ~ COIOA OR RACE 7. MAf111tE0 ~ NfY[R MA11111E00 DATE OF ~~11TM AGE (1* /tp~ r~a~ f TW1 UADC]t N N13. ~ . lwf0lrlN~/) ilww Pw~ M.w Yt~; ~ MffpOwEO? dMOilCEO ~ ' iG. uSUAI OCCVIATIOM (OMelf~f yra! iWw~ I~.IIINDOf ~YSIMESSOR INGUSTIIY II. ~HITN/LACE (3Y~lt M~ft1~I IM~~Ihi) 1. iITRD10R MM~T GOM(iRtl . ~wiy ~at d w?!1*I hfi. Mts IJ ryf4el) • 1. FAIKER'3 IIAME 1~• MOTMER'S MAfpEM !!AM[ s i ~ 1 trAS OECUSEO iY[R IN U. S. AIIM[0 i011CESt 1. 7pCUl 3[CUQITY M0. t7. 1MIOMMAM t f1011AS'Y~ . t r... .....+f w~.? uI ~r.. w~+ w. s r.w d..w..? • Atbut 8 1~. CAY~t 0/ KATN (Ll~ta ad/ ~at aw+Pa twJ~r p). 1a1. ~AI (t).) IIfTE11YAl ~ETriE[M :F; MO OfATN ?ART1. DEATNWAStANSEO~Y~ ~steriosclerotic heart diaeaae with ro ressive ~da s IM~tWJ1Tt GtNSt (e) . myocar a ~ecompenaation. . J: GysllfiMl. (f~ pM/. DVE T'O ' y!k? /W+ ~ ( ~et cw~t ~ • • uaN~I t4t x•in• OV[ TO (d x l~ly tuut lut. O tAAT 11. Ot~1 SKar/1CAMf CawD(T~Ord OO~tT1!!wl~rai TO OuM R!T l10i Rt1A1[D t0 Tx[ Rltrw~l OR[Af~ OOIIOIt10~1 GIMLM M/MtT 1(~) . W A OPSY ( ?(RfpRMEDt . ~ . . . _ 3 . . ~ • ~3~ ~ ' 7~~•' ~cc~aMr wQ ~wnKia 240 OESCNIlE 1101N MUVIIY OCCURRED. (E~f~? w~fWf Htilr?f !t~ PM! /K PMt t! yrrw . ~ • T~ ~ . ~ mc. Tir[ os H~r N~ntl. Dq. Yrr i rruuar a. w. ; s. ~ i 20r. n+~uRr aeueR~o ~o~r. ?ua a nuuer 1w «.e..r ?.we. 20!_ anr. Tow~, oa ~ouTaa aourm st~TC ~ - ~?qKt AY ~ MoT wnK.[ ~ 1~ I~f. ~frtN. ~da OIN.. Mc.) { - ; ~S ~ 'i YIN1lK AT WQAK ( 11. l~tr~nd~Q tA~ dro~ae~d/roen n~s.: ~l.~ ~b~,. ~o ~adls~t wl~iw ~lir~on D~C. 23~ 14~~ t , i DwtA oeeuind ~t 1Q A~n eA fA~ d~f~ It~f~d ~6w~~; ~nd ro tM AMt o/ w?~ Rnowhdp. IroA+ Ms eau~w ~UfN. i ~ f n. ~u?TU~c (DM~fH N ~IIG) ~~~~"`~ix th Avenue, South ~ °An s~c,~co , , " • St. Peterab r 1 12/24/63 i ~ Y]~. ~VIMAL. CRfWITGM. . 2~~~QAtE t - • 23t- 1iAME OF C[METLRY OR CREMATORY Z3/. Lp[ATIOM (GY/.lNi~. M tM~4t/) I . M . ~ ~ • ~ ~`YOY~` 1D".: ' ~ ^ e t Petersbur Rural Flo , ~ ~ ; ~ FML Dip~ T ,IG T T p"~(SS - 25 OATE RECO. ~Y IOCAL REG. ~E RAR'3 SIGMA U E ~ ~ ~~~~~1~81(~`-c,entral Avenue _6 . . # J,~Q',~~~ f~ 07~ • ~ , . , _ . ~ . _ _ , . . t +1-~7:.l~' ~ r. " :a:~'~C- ,t!-~ r~ ~::ir ~l:f :~`a.t -s' ~r.'~".~• ,1, ..1 ~ r~~iR~i~s~~~ ~aVk~'~ ~'j~ - ` `t1` r~~'~2 . t. . ;~;.Y.~: .:~~~~'4~ .-~j'~.t t - ~,-.a-i•v.T: =1~ w:Sct7i!.~, ; ;~-`a; a ~ ~~~'~~):s~i,;_ ?=~,1:~j`;s~i.~ Y y s ~ ~ ~~i~"t1 _ 4, j ~ ~•v ' j '.~~-f!i'~1~.`j~i~~{ . i.s_ _ ~~i~~ ~a..~,;/i~~~'ia:~~. ~3 ~ f r :~~:`('1'~~:.~~~-~~~~'f:t°`~ ~ . . e~,_ ~=:m.:~:'- - - - - ti . i . . ~ ~ , 13a . .l r~~ ~ ` ~ ~ FILED AND RECOROED 4~ . I(~ ' ' ` ~3GOK ~ . . ' . 19G4 DEC 4 _ ~ . ' , , 31 PM Z; 32 - t ; - ~ , ; ~ - RocER Po~rr~AS. c«~n ~ ~ ` ~ _ ~ ~ St. tUClf COUNTI', FLORIO • ' ?t s , . ~ . ~ _ . . . , f . . - ~ ' ',li~ • ~ ! V . ~ ~ ~ f S I • } - 4.` t 1a .r ~ = • `~'~A~ ~ " r . i t ; E ~ se~? • ~ ~ ~ ~ . _ - ~'~a « . _ - - - _ ~ , ~ ; ` .i _ - - e~~n ~0~` r~w ~ o: R~ ~ ' cr 4g~ ,1 ~ g. . . . . R