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HomeMy WebLinkAbout1205 - _ _ ~Q~~~~. - . ~ - ; • _ ~ CERTlFlCATE OF DEAT.. • . ~ty~~liwlwl ~ ~~e~~tti ~ncl ReMI~illblhe .~~tnlrn ~'TATI ?II.R NO. . ~H~~x?r or ~?i,i.m F L O R I D A ir?e. oe re~ut ~N . . •'~••••w....,.,~ra. . . ~ . ` 1liMAMQNT IMK RC61tTRA11•• NO. 6 S 9 t Sff 14i0K~Ol fOr OfCEASfO-?JAM[ ruf~ ~~oa~ • uf~ SEX DATE Of OEATX 1 rOwiw, o~~, ~~u ~ ~ = ran~crars I~IILLI/1i i Ti:EOJOR : '.-IOD"J:~: ~ ~~;..I~ , ~eceriUe~: 29, I~74 = , ~ACE ~«n. NfOq. ~W~K~M urouw, AGE-~~u u..ou ~ n.~ w.oi~ ~ o~~ OATE Cf ~1RTH ~.~a.Tw,~o.r. COVnTY Of DEATM i IIC. 1 MICNt 1 ' M~t 0 i 1~l~~i1 rp~. p~~! ~OV~1 rw. Tv~ 1 - ~ ~ t~Tiite ~~3 „ ~ ()ct.2G, 190G Sa~.nt T.ucie • ~ G G O Z C(fY, TOM'N, O~ IOCAiION Of ~EATH wsme t~n ~r.ny MpsryT~~ O! O'MER NSTRUT -NM+f ~n ~.o~ ~H ~•rr.i~, ont f~N~~ •..p .hry~~ ~ . sr~u~. r/f O~ wP ' - i - n? oi~ Pa.erce ,,~'es ,~;~~rt Pie.rce Aie.~orial I-.osPital ~ i. STATf OF ~~I1M ~a Mot ~r v.~ GT?2EN Oi WruT CCNN+i~Y ~WRtEO, ~+EvER wubEO, ~URVivNG S?OUSE ~ r.n~. o~i r.be.. wr ~ ~ ~ ~ " coN.v+• w~ppwFO owOI1CfD~wcr.~ - . ;;;er~ ~'ork City , iiS:1 .,1~:xzeu [~ii~clred j•la::d ~ ~ uveo ~ir~~se~a~ SOC~M SEfUR~TY NUM~E! ~ USU~I OCCUMTpN ~om ~wo o~ rw~ oowe ow~.a .os~ or Ky~p pf WSWESS OR INOUSTRY _ ~ ' _ ' i ocewaeo r~ rrw.u.a we. lV~r U qn1t01 : „ OG5-09-21~2 :Zeal. LS'C1 ~L' ~ro::er iZeal ~si;a ~e ~ ~ ' ffYOir~t~ MW~! ~b 1)? ' ~ - ' = ~~""N'~"• ~ESIDENtE-Sf~?f COUNTY GiY, iOhN, OR lOUT10N µswt c~n ~~rm S1tEET AtiD NVM~; g , l---~ lo~:ida ~ S`- Luc~c ~ ~ a ~23 ~ 3 ; _ . or~ P'e_ce Yes ~,,,1~ aysnore llr. , ~ : /ATMER-NA+Nf ~~n1 - ...oae usr +AOTnER-MiUDfN NAMf ~~rs~ ~ .~oa~ ~ " Us~ ` ; _ „ ~z~hony liodun Theres~ Yahley ` I WOiM~t~i-t+M+E r.wK~riG wp0aES5 ~u~ee~ o~ ~.r o. .w , em w~ow~, t~an. iv~ , - ~ - :iildred i:. l.odun :,,1223 Paysiiore Ur.,F~;.. Pi.e~ce,; 1 33~~0 $ , - ~~i OEAiN WAS CAUSEO ~Y: ~ - ~ENif/ QYi~ ONt CAVSE Ift tWF IOt (o), (6), Mb (~Jl ~ •~~~a"'M ~ u ~ Nf~11M OM{Zl ~rq O~~Ti1 S e li , MrtOUR CaV1! . - i , . _ N ocardial. fnfarction - ' - 2 ~irs. . ' . _ . •1 • M317v ~ . ' ~ ~OMD1110M1, Ii IM. ' ~ ~ _ ~ _ ~ -M.~• o.•~ ,a ~b, Arteriosclero~ic heRr~ dise~$e ~ 3 ~ra~, . ~~rlO~at! C~Y:~ lor, OW t0. G~f ~ COw)lOWi+C~ M: ' j } _ ~t111M0 tN1 VMYt~• . ~ llIMO C~VH t~tt ' _ . _ ' ~ E (c) ' , ~ ~ ?Af( OTHE~ S~CiN1iKANT CONDII~ONS: ta+ar.o-.s to..~u~ut~w w oe.n. r~~ .w~ ~tur~o ~o e•u?e Gnt~ ru~ . ~oi IAJTOISf = ~i' yES ~~~e /INOtMGl COM• ' y i sll~d\+O' ~ L~CIl~D IM qif~~Ir~tnO (.~V3~ j • - . ~iti \V~ ~~_1~ OI~tN ~ ~ i {r.•bobl~~ ~(GDENi, SU~~~DE Ol DATE Itt1UtY ~MW+7M, pA~~ rt•~~ HOW _ IM01~v IN)Utt OCCU!!ED ~ ~~Te~ ~•wN C~ ~~~vn •w ~ w•a~t r.~. e~ ~ ~ ~ l~OrKrOf: Ot w~OEtElr~rt[D ~ ~ ~y~ - - I~. - - ~ ! - INlU~Y At Wp4K , IuCE Oi w1WY .o.e. r•~r. senn. ..[~w., LOCATiON . s~e~i~ oo ~ ~ e. wo , em o. ro~w. s.•n ~ _ 1?IfC~A ~~1 p OI :H~Ct MO4.IY ~S+K~nI . . ' . . 70. ' 7'B~ . ~ JOq ~ . ' _ ' . . ~ ~ ~ CE[iM1UtiON- .wr~ n+. re•¦ .own. ~ o.. ~i.~ , u.o us~ s.w w~..i.~~ ~i,.i o.. , o~o/oa w~ .,er ny ot~rti ~ttunto .r n.f i - /MrSK~~N: ~ - . ' .w~..n. n.. et.~ ~ ~oo. •~rt~ e~.n. ?ue~. o» me . . - ~ •niwoto t.~ TO ~ •w ~ ~ww• ew.~. •..o. io ~ Kfr t . _ ~___7 . 1~ 29 7~ ~.2 2 7~1 dfd ~ fj p o... ~.owuoee. ow _ ~ . tt~ rett.uo ~•o. ll ~ , 2~~ 1 l7ic 9 7~ ~ 2~ i 33 M~o +n~ t.us~~s~ sT.no. ~ ' _ _ • CE~TU~UI~-~D~CM Exw~uHE~ Ut COROr+f~ a. a.~~a a nw o. a.,,, TlM~ ~(~~(MI ~1~1 ~W~IQIM(IO O~~O , . ~aarrahp+ W n.t WOr ~~+0 O~ •M ..evIS~~G~rO._ ~ r• p~w-aY~. . - . - . oi.rM oeevNeo a+ w.~ e..~ ...o rw ~o ~.e e..no~. s~.no ~ ..o'+rw o.~ •e.• .ov~ : ~ M,tr? ? 2 ~_2~_- ZLI-------= 6 ~ ~ .M ~ i CERititER-H~,MF ~nn o. i~..n ~ - - ` f 5~~~ ~ aan~ o~ O~iE SiG?+f0 ~~w~.*w. oar..iu~ - ~ard D Ro~~1~.D. ,~:.,.ti~ti.{ x~~. / e~~ ` D'~~ 1 2/75 i ,N - ''"A"W~2~'~"s~T`~~i~a yista Boule"va~c~; "~'ort St. ~;uC~~, Florida 331j. 2 r~• } ~ a ~ _ ~URtAI; CR[7~VITION, REMONAt ~CfiwEtEer Oq ~eEr.tiwi0ir-N~,~,F ~QtAiiOt1 . ~ n Oa qo.. t~~r1 - ~ . ~ i . ~ snCir. ~ ~ ~ . - ~urial ;;~~',-iillcres ~;:e:~. Gar~.e:~ f'or ~ P:ierce, : lor.:i.da - ~ OAIE : rp...w, p.r .~at~ "-~fUNER~I HOµE-~:~ti~f ~r:0 aD"~RESS---s,.e~~ o. ¦ r e. Ko . e~,. o~ ~o.r s~.+e. - . } tu,J. ' 3 l~i`~ ~~s.~~a4es ;~L:i CZc ~;:O:.G~i'.~l.i:,0:;777~.•`i;. i 1~1'CGiI~~. 334-5n ~ ~ ` Y• S. 1(+1? F~HE~ l O~t Tp~ ~ REGtST i-SIGN~fuff o~rE ~t ~rtQ tOC~I ~F i~e~~ ~ e~~. i9io ?s. - r?, ~ . .,,.rin-~ ! ~w ,~`anuary ~i , 197 5 . ~ , - - - ~ . ~ : - • _ - i14,~Df;~C+ ~f~~:~0E0 ~ . ; ~ ~ tu•~~;~: ;~,~:kTr F~a. ~ - : - I harsby oortify thls to bv a truo and correct copy of iha LOCeI _ Ri3~: •'~:"F.AS ~,t~~ - . ; ' Rvqi~trers record on f~le in thv St. tucie Gounry Hoaltl, D~r~art- ~i ~;~r. CGI;RT - - ment at Fort PiQrc$. Florida. _ n~t,;i:,~ ' :t . - _ t ~ ~ ~ ' ` _ € - (Wat~iny: Not valid unless ra~sE~i seal ~f tha Si. L,xla i u ~7 ~ f~~ - r' ~ ~ounry Ne~~~h Department is af~ixeci.) ~A'~ ~ ~ f ~7 i 1 ~ • - , t ~ " " ,1 _ ~ - . : - . ~ SS ~ i y ; N. D MItIER, M. D. n Q - ' t ~Hwith Off~ur d. I Rpistrsr ~V~`~~~ ~i.r.~ ~ _ ~ Cflh ,J ; ~ ` , i` { f / - - ~ ;l `~i~.~~,~~' - : ~ G _ ~ ~ . G~ . ° `~i : - : _ . ' - / Gr.~ D~-?iutY ~«s! Rw ~st~sr ' . ~ ~~/J 11~1 , ~ , ! - t - ~£a', ' t ; _ _ - . ~ _.s aoox239 PhcF1`~,'04 ; ; _ . _ - _ - , _ _ - . ; _ ; _ - . - - 1 _ . . . 5 . : . . . - f . . j