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HomeMy WebLinkAbout1176 f . . L:;~ - 5, ~.i~~ ~ . i • „~yT-. `}~~a. ~ ~ ~ l~, ~ ~ . ii^.1 ~ I , i.,t~/'t~~h~~ . , ~..t , .~1...._..~. ` ~ ~ ~ Ma~ I~ li uu ~h~' ~ . , . - ~~'~~ti1~ r ~ ~ . , _ ~ ~ _ , ~ a . ~ . - ~ • - - - . _.e~.:. a~ _ j~ CERTlF'iCATE OF DEATH ; Ikp.r+.cnt ol Ik.leh •nd Rc6a6iluau.c ~kes t7'ATE FILE Ho. ~ - Mv~,xa+~ ~iraciri F L O R I D A ' TY?E. /RINT IN ~ ~°w~~~~~~ - ~ ~ . t•- ~I!(t~NT IliK REGI6TRAR'S NO. , F SEE MA~OIOOR fOt OfCEASfO-N~Mf ~~~sr r'OOtt ~~tl - j~X OAiE O~ OEATN ~~oMtN, o.., n.~ ~ ~ : _ "s~""a'~ ~ Elsa Zie ler ~ :Female ~ ~ Janu~r 14, 1°75 i RACE vnun, Mlato, u+tuuw ~»ouw, ACsE-u~~ v«ote t rt~e ur.et~ ~ o~r DATE Oi tIRM ~+~o+~rh, o~r, COUNTY Of OEATH ~ • erc. ~ueu~~~ ~nmo.. trt esi ..as. wri ~oiru ..w. - ' ite ?4 ~ - ~ Nov. 27 1900 „ Broward . j Cti1f, t01NN, OR tQCwTION OF DfAiH wuoe cm .u~un HpSMAI OR OifiER ~STtiUilpN-NM~tf r.~ ~+o~ e~~~e~, cro srno uo Muwt~ ~ ? ~ncm ns o~ wo ; ~ , n derdale Yes ~~.-HaI Cross~ Hos ital y - STAiE Of i1RTM ~u MO~ IN y,f.~•. N~..t GT12EN Of WFIAT COUNT~Y MARR~EO, NEVER MAItRIED, SURVNNG SPOUSE wue, arce w~otH wwt ~ _ ' -to~w~nr~ ~ _ WiDOWEO 011IORCE ~uKmri . ~ ~•~•us«~< < G~rm~n U.S.A. ~e Widotnrec~ ~ ~ ~~xD SOGAI SECUW7Y MlER - USt1~?l OCCUMT1pN ~are c~NO or wpea po«t ow~.a * or i tneo. u ot•m tb4 KWL~ OF WSWE55 O~ It~USTRY - p~~~0 ~ - ~ w0~[w0 UN, M+~ U ~lht[' ~ . . _ - t _ _ 70 ~ House~vif e - Own Home nyoeace ~ero~e ~t RES~DENCE-SI~fE . COVNTY C(TY, TOwN. OR IOUTION ~ N+s+~e ~rt* ?wm STREET ,wD HUM~ER . s' ~vecur rei oe wo~ - ~ ~w rida ~N.Broward ~k Ft.Lauderdale ~~,.No 4820 N.~.2~d.kve. ~ FAiMER-NAMF ~~a~ Mipp« u!! MOTFiER=MAlOfN NAME ~~nt +u6W1 , u.ft ~s - Jacob Rein Paula Lutz INfORh1ANT-NAhtE MAlING ADGRESS • ~s»eer oe a.r.o. r+o., cm a+owr., si.n. ta~ - ~ Heinz W.~ie ler . ~n 4~51 N.W.19th.Ave.-Ft.LaLderdale, Fla. ~ ~~t OEATTI V~AS GUSEO ~Y: EMER ONLY ONE CAUSE PfR LWE iOR o, ••?~on+u w ru _ I O fb). ~ f~tl ~!M![N OMylf ~wD D!~ t~.-_ r..eoun c.vu - ~ N~ ~ Monom~~elob~a~tic leukemia - - - l_ mo. - _ ~ ? ? N . - - - . COMOIiIQN3, 1~ ~1R, ~ ' . ~ . " ~ _ .M~cM c•rc •~se to ib) - . = ~rreour~ c•vst ~m, out ~o, w~s ~ co«xoua+ce o~_ } ~ l1~i1N0 TN! YMOl~- . ~ lTIMO C~YSt Uft ~ . ' 1 t`) _ ~AtT Y. OTHER SK'iNIfK/WT COt~WTiONS: tawpnows <a~neavnwc ro oun~ wt MOI ![U/iD f0 UYS! Gf12M IN ~Ati 1101 ~~T IF ~ES xc~t /IMDIM6S CO _ ~ns oa ~+o~ Houto aneer~~~r.c uu . . or or.+e ' 11~. NO t11 - ~ieby1 KdCEHT, SUK~DF OR ~ ~roMTM, yr, r[~a ~ FIOtJR NOW INJURY OCCURRE~ l E~rt[~ wN~[ O! ~NIYb ~M Mn ~ O~ /~~1 tt, rtt~ t~ 1 - iipwt MOEj O! YnGEiERMINED ~ ~ 70~. 3~t M. 2M. INJURY AT WORK ~u.CE Of urri/lttr Mo.e. ?.a~+, u~err. r.c±oe.. IOCAiION - ~ fnen o~ i.r.o. wo., an oe ro`+?~, sr.tt ~ ~ t fMan r[s oe Noi anu Koo.. [rc. ~ s?tt~n ~ - ~ _ ~ ~ _ " . ~ ' . ~ ~~~FI~ATk'~N- rprr~h ~ QA? TFwt ' rOM'M , D~~ fW utD 4St S~w MW/M!! AI~V( ON 1 D~D/DIO r+Of YtM M! OEATX OCCURIED ~t ~E ?l~Ct, Ow Iwt - ?XYf1~lAN: . /y~ - MQ`~M D~11 t1A~ {00~ A~1tt 0[~M. tN04~1 a,n....a, ro~+~s k 1 AT?INO~O fM~ l~/ I~ ~a 1/ 14 /..7 S 1! 13 7 5- a.. o t!~ oa~~sto ~eo.. rs~. :,,.D i d I~1 O t 21r : 2~ t~. ro n~e uust~s~ s*•a ~ CERTIFICATIpN-MEO.CAt EXAMtNER OR COAONER: ow mt t~sis cv tMe ~qyi ~ p~~~ tMt ONfDlNi M~1 ?tOnpJ~aCED Dl~D tLwtr.~i~ON O! tMt aOJ~ aMD/Ot ir1 u.'rtfTlG~rp.v~ ua rr O~w~Ow, ' . nOeRN O?~ Y[w~ - r~W! OlAM OC(UfttD OM M! D~7t YiD DY! i0 TM[ 4Y3[l31 St~TlO. - - ~ . n. - rn - . CERTINER-N~ME tnie o~ n~nn 51GNATU e eee oa * s~ DATE SIGNE~ ~.w~.TM. o.,, *w~ . ~ n.. Howard RoAbel ~ t4t.D. ri=~ - ; ~ ~ ] /16/75 _ ~ ~c~no~E~s3"5~.~-.17th.Street s~n:~~••.•~ Ft.~aui~erdale, oric~a - ~lJR1Al, CREMATqN, REMOV~I ~ CEt+iETERI/ OR GREMATORt-N.uaf tOCnTION _ un ee ro.~H sur¢ ~ . 1 SIKI/t 7 ~ ' - ' - n t~~. ABCO Cremator Ft.Lau~erdale, Flor~.da - ~ DATE ~rDxrH, owr, trtw~~ ~ iUNERAt HOME-NANf ~..ND ADDRcSS ~ sT~ter Ot e.r.0. ..a., C-~s O~ tOWN, St.re, ti? ~ :W. 975 ~ts, ohns-~8 0 ndre~v ve . t o La. der a e F1 a. E612 fuwertwt o~eFCroa-srcrurua~_, ~ REG~31R~ SlGNAfUQ€ ~ /,~t DAtE E j~rED ~T IOC~ tFG~/S~ a ` RiV.19T0 fA ~/-~Gt '!~.'.~'~~r?~ tN_ ~/tti^4r' ~ LV~' t 1N. Q ~ V . ~ - CERTIFIED COPY , . - - - ~ I hereby certify [he above to be a true and correct copy of the Lo~al . i ; - Registrar's record on file,i~ the Browar~ County Nealth DeparOment at _ _ FQ~~~~~a;~ale, Florida. . _ ;-~~puc~;r ;IF,'~t~, - - _ ^ t~,,, ~it • - - . ~rning: .~ia~~v3lid unless ra~ sed seal of the Broward County Health - ~ Y . . ~ ` i ~ =1:E5}~~'~s~~D~~ent is affixed.) _ . _ . - . . ; : - . - = . r,. - ~~Z~y _ . . . :~~~ft~f~GEi:G,1i.E ; c4 ; - c~ % I ; ~~a?~ ~ County Health Offic and L,ocal Registrar ; ~ =''rps~ z ' - ~ - RECORD AND RETURN TO ~ - ~ - _ - . ~ , : ~4 ~ ° ~ SA .!ES A. G~ELER, !R. ' IT , 4: d00 E. PR~SPECZ t?D. ' ~ - 800K239 PncE~,~~~~_ ? . Deputy Loc~' Registrar ~ • ~uo~:.on~E, F~. ~ ~ ~ ~ - . . - r!w.. . - _ _ ~ - - ~ - . - - ~ - ~ . ~ . . _ ~ - - i