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HomeMy WebLinkAbout2001 - ~ ~ . , . . . ~ ..26 ~ ' ~ `i DADE COUNTI~ ~ a ~ ' DEPARTMENT OF PU~3LICJ HEALT~i - - 1350 N. W. FOURTEEN STREFT ~ . _ ~ - biIA14iI~ FLORIDA 33125 ' ~ - , • _ :s~~: ¢ . . _ ~ ~ - UEPARTMENT OF HEALTH & REFiABILITATIVE $F.RVICES ~ ~ _ , DIVISION OF ~iEALTH ~ I HSREBY (~Y.- Z~iIS TO HE A T~7E COPY TEIE LOCAL REGISTRAR'S RBCORD C~' DEA _ ~:~~jtl[l ~ j = . S ~4' ~ ~.'~a`~less the raised seal U'PY REGIST ' ~ $ . ~ , ` .'~~5k~~~ i~~t ` 7~ , ~ th ~~~l1~;of Vital Statistics VITAL RECORAS UNIT_ y ~ t~ F ` MIAMI FIARIllA - . S : s G2 ~ • ~ - _ . ~a~~-~`-~,-. ~ - . . . : ~.i f ' _ ' . ]~S;'. r'1,:. . - - 'y~.•, . +~...~~4f .~~~~.r_ - ' ' - . ,,L.,: ~ t ~ERTIFICATE OF DEATH . : . F~epariment ot ~rl F L O R I D A s,rwTe ITILE ~ro. r; ~~i.'~~- r . _ IN . 1O~° ~I~,1o _ - ' REG~S~@9.FLSr NO. , +K DECfASEO-NAME ist, c}_- : ~+~oou SEX DAiE OF pEA~tl ~ NONIH~ o~i, ~ew~ ~ . ' ~R ~ MAY ~t 1975 - . ; - ~ :=k~I~i1~ENCE C. ~ Female ~ ~ ~ ti KEEHER RAGE ww~1l. N~GtO~~AYRi1CAN IhD1AN~ ` ~GE-~.st UItOl~ ~ 1lli VMDL~ 7 OI1V DATE OF 61NTH ~ w.+~~, n~r. COUNIY Of Df~?TH ~ - E7C. I S?lCIi71 {~[IhDl~ lti[aR31 YOS. 0~~3 MOUtS u4:. 1[~l l . _ . . " ~ wtii~ - s. 69 . s. s~ - ~ JULY s, ~~05 D~os - • CfiY, TOWN, OR LOCATION Of DEATH ~ws~oe t~TM iw~rs HOSPITAt OR OTHER INSTITU7lON-NAMf ~~r ~+oi i~ ertnta, e~vc snete ~~o rii~.~ti i - - 3•""• JACKSON MEMQR I AL HOSP I TAL ~ ~ n MIAMI " . YES j+ _ - . STATE OF llRift ~ u Not tN u.s.~., Nwre CITIZEN Of WHAT COUNTRY M/1RRIED, NEVER MARRIED, SURV(VNG SPOUSE i~t wUE, G~r[ ~~DE~+'+~yt 1 - ~ tou.+nr ~ WIDOWED. ONORCEO ~ sr[cu. ~ ~ RHODE ISLAND U. S. A. ~Q MARRIED TfiOMAS KE6IiER SOCIAL SECURITY M1MbEQ USUAI OCNPAi1QN ~G~re t~NO or w0![ OOHt DU~u+G ~ost O~ KIND OF 6USWE55 OR INDUSiRY _ wOt[i,+G l~/t, hEr+ t! tf1~llO 1 " ~t 039 09 2517' ~~,_HOUSEWIFE - ~n. OPIN HOI~I; _ ~ ~ESIDENCE-3UiF GOUNTIf CITY, TOWN, OR IOCATION ~~s~ne un iw~TS STREET wND NUwtbER _ . u.ee~n tES o~ Noi ~ '~N FIARiDA - ~NST. LUCIE ,~n~RT ST. LUCIE . _ ~~a YES ~~~3096 OVERBROOK DRIVE - fA~NER-NA!~E r~~ti r~oae use MOTHER-AAAiDFN N~Mf ?+~sr _ r~opic ~ ~ ust ; - ~s - PEIiLIP _ - CASWELL M~1RY FLOR~NCE SI,OCUM ~ ; . , ' INFOR1WMiT-NAME MAAt1iG AWS~iE55 ~ fsreetr m t ~.o. ~+o , C~Tf O~ IOMN~ at~rE, tv~ ^ THOMr1S KEE[{ER ~ri3S}96 OVERBRt~O1C llRYVE, PORT ST. LUCIE, FLORIDA ~ ` ~ PART 1. ' p~TM WAS UUSEO ~Y: [fNiER ON(Y ONE UUSE FFR UnIE :OII a, AND c ~ffp71~'~ Y~1 . fbT. 11 ~err.te+± ohset w..a ot.r~ ~...~:o~,re uuse ~ ,;.!~~t fLA: CORONARY ARTERY D I StASE f ~ ' ' _ ~o~ ~ji tU•-~ ~;~,c . , ?1 ~ COr~StQtilrl 01: ^ - , ~ l'. a . " (VwDtnOM1. ~ RHEUMAT I C HEART D I SEASE { ;..a- - . • . w~icM c~vt ui[ io (dl ` . s ~~4Y(Dl~t( (a~jSl 101. OVl t0. O! AS A COMSfOVIMCE O~~ ~ S ry d ' st~.n~o ~~e uwoen i~ i ; uiKO t~use i~sf {'fl11 ~O v ~~T ~ _ _ (c) - - - ?ART p. OTMER SIGNItKANi CON~l110N5: ea+o:navs co~rtti~uriHa ro ot~r~ ~ut Mot t[utto ro c~us[ ~rr[H rw~r i ~oi AUT!OrSY- li YES Metc nr+o~MCS co+a F ~ ~ 17lS O~ NOl f1Dlf! IH OEillylntNG CAYS! i - • . - ~,,YeS If~ °~~`~5 - t (?~i~ 1 AtU ENT, SUIC~Of Ot A Ml' RY tYQNiM, DA~~ rta~ti riOUR -HOW INlURY OCCU~RE~ ~lMtll N~~{!tf O~ ~Nlilf~ IN r~ar ~ o~ ?.~r i~, inr ~ lqMIC~CE: OR UhDEtERMtHED ~ ~ . ' ~ - . €f _ . ?0?. ~ " 7Qc. ~ M. ?01 . - . . . . 1 . IHJURY AT WORX ?IACE OF WRlRY ~t Mo.~. r~ir, siaeT, ~~tTC~r, IdCAT10N ~ ire[ci oe e r.o_ ro., un oa towN, st~tt ~ _ _ . k I f/it~/Y tf3 Of MOI OHK[ fIDG., fit_ 15?[Cf~T / ~ - . ~ i Lb_ ' A1 " qp , ~ ~i7 i CERtIfiCATtON- .~o~tN 0~7 ~ - TtRI ~~M OJ~f ~ta! w++o us~ L`+ wwlnEe rint ON t DW/DtD w0/ ~iE+r M! DEAfM OCCU«ED ~T ME ILKt, O.~ tnE ?M(SKIAN: . , 7F~t { ! Ot~iM_ ~ ~ 0~'!, usD, f0 1.Y[ NSI ; ~ wnENOCO rMc ~Y 7~~ 75 To MAY 9, ~ 975 ~MA'P"~ , ~ g75 r~ OSPM w r~ cww~txe, o~t ~ 2li oecewseo rro« 71? 71c til 21~. - - M ro rnE C~uscuz st~tto. ~ CERT~IGTKNV-1AEDlCAI EXAhVNER OR fORONER: or+ rN[ ~~s~s o: Tnt Koua or oca~n t„t otccothi w ?lOftOtSMCiD Df~4 ' lt4~w~Tqta M M[ MDY A~+D~GR trf ~rnlSirG~TqN, ~r~ rT O?uiW.+, - ~ rOnin 6ir •E~~ fpu¦ DE~M OCi4~~ED OM ME Dan ~MD OUE i0 tnf ULS[~S) S~AiiD_ " ' - ~ - 2'h ' - 71 . M ~ - CERDflER-NAME mn oe ~ur.n S~GNAT oF~ect DAtE StGNE ~.~NTM o~.,~t? h ° HOOSHANG BOLOOKI MD _ ~ - :k S ~ - tiu~tu+c_~oacess-cEar~F~R . 1700 t+1:"`W"1~~~ AVENUE MIA'PIP` ORID " 33I3G•" ~ tw - ~ {lAt1Al, CREMATION, REMOVAI CEAIETERY OR CREMATORY-NMtf LOCATION C~~* Ot IOxH S*a7E ~ 1 SKCIR 1 - t~. CkEMATION - 14~ DELRAY CREMAfiORIUM t,~ DELRAY BEACH FIARIDA DATE c.+p~rn o~~, ~t~s~ FUNERAI HOME-NAMF AND AUDRFSS ~ SteF[i ot i.~.o. No., e~tr Ot iowK, S~~~e, l~?r _ =i, MAX 12, 1~75 ~~JOSEPH B OOFER ~ SON FI3NL•:RAL HOME ~.U931 NE 6 AVE. MIAt-SI FIARIDA • fUNER IRECTO~-SJGN TURF REGISiRAR IURE OATE ECEIVEO ~T IOCAI fFGISTR4! - 15~. 7H ~ ~ ~ 7N Q z~s~sa~oc:--~ _ _ - - - ~ ~ - _ ~ .