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HomeMy WebLinkAbout0462 , 1 ~ r - • j _ . f , ~ , . - ~ - . _ . . . . . " ' CEF~71F'ICATE DEATH ' - ~ ; ~ Otprr~eN .f lie.t~~ .w3 Rc6.6~1uu1.~e Sc..l~~e. - fiTA7R rnc Ho. ~7$~ ~~ff~~Y~~ F Y. Q R I D A RE41iTRAR'S NO. fJ67 ~ ~ ~iTI[. 04 fttN? IN . ~~~'R'~^'^"'° ~ ~ NtMAMfNi INK ~ ' 1 . .Sd~ ~7t00[ (Ot . a~1~ rna~ SE7[ . CAtE Of OEAiM ~ rowi., e.r, ii•~ ~ e ~ ' rirwaw.s WIIa.I~1M - - L. BSAI~Y~~RD Ma1e Ootabex 3.0 19 ~ - ! I RACt ~nxft. wtcw. er~.c~w wwuw. ~~-i.f~ uMOe~ ~ st.~ vwt~ ~ e.r OAtC 0/ NRM ~raww. w~. COCMTr Of OG~Tn - ~4~1 ; IK. IWt~ltl M10~?~1rua~1 +Oi. Mr~ wOM~ w. . ~ , ~ Sa. o u - k. June 5, 191]. St. Lucie . . ~ f . iOYVH. L T A s.o-re c~n ~rm „pSryTqi OR OMEt NST U! - ~r nw w ema~, ony ~~K~~ .+o Muw~: . ` ~ 6609 : ~ :~'t. Pieros ,R"~w Iv'arth Fed. FLiSY~Y. Rt. 1, Baac S~ t sT~tE Ot wtnl ~r r+o~ r. u.~..., ~ C~T~[?~ Of ww~i CO~Xtiltlf ~IItuD, t~vER wtNtpEO. SWVNNG S?ObSE vw, ows r.re.~ ww ~ f . . _ : i ~ f V~ ~iR~ I YK~f 1 o,.~1. ~+,~7.~.,,,,7 ~ . . Y~wlNtot~K1 1. ~ 1. N. 11. ~ua `~'j~~~ . - ' ' 1 ~ ~MN MC[~MO , - , ~ ~m~. a a~s SOCIAI SECW7Y ~ NSUAI OCCWATiON t4~7 awe N~w~ ~o..i oww0 noa o~ RWO 01 WSRrlSS W t?+DUStRr ~ , ~ we r~ ~or . ~ ~ nu i - B].BIyG~'k~i~ '~1IN3$ ~.'Ql~J~1I111 ~ ; ` ~ ; : ; , *w.., o~. u. 020-07-173 a~' ~ ~c w~M t~n tWq STREEi /Mi0 NUMif~ - • i •Mw. lfS~DEMCE-SfATE - C01Mfr U71/. TONM.Ot tOC~T10N t Wcar r1~ O~ woi l~ ~Q~ 6.5 - j ~aF1~~21 iw. St. I+~1Lj.E Ft. P~~~C2 ut NO ~w.N. Fed. ~ tiWcl '3 - ~ ~ . ~ tA~ME4-NiIME iNH wMF~ uf1 . MOTMER-MAk7FM NM~f !MN rM~l uif i ~ ! . ~t. r ~Y ' B1,anChard - , u. _ ~7t21e1 QiShi. ~ ~ • _ _ . ~ • ( [Wt 11i ~~~.1 w1~iMG pDGRlSS - :3MH M ~.IJ. MO-. t~h O~ lovrr, luit. trl - , 1 ' ~ Rt. 1, Bcac 65, F't. Pierce, Flarida 33450 ~ . Nut 1. G:AM WAS CAYS.EC ?Y.• . - (ENtE~ GMtY ONE GUS_' IEt lw[ f0~ hJ N~ ~(~1I ~~ei~ii~ o~sii a.o a f~ ~ ' ~ N. _ ~ - . i i ' ~ • r~ .s } j ~ . ~ - N~ S ~ • . . . C6MM10M~. 11 i~n, ~ ! 4 _ ' . ~ { i ~ .w:t~ Oa~t hit t0 ~ • - - ' ~ ~ . ~ ~ . ~ . ~arlM~~l C~Y~1 N~, M 10. 0~ at w CO+MOWrG pi . . . . ~1ltIM0 tIH rMa~F ~ ~ i?we c.rp u~r • S } <<~ : ~ . ~ ~ i• fMt OiNEa i Cp+WT c no•n c wo w M .,n..o~ .n~ ro a~ aw~ r ~ IWTG?Sr V YES .t~~ ~~•s~woa ca+- _ , ~ ~f ~ ! • ~ns ' a ii~iww N~~uu.wa cwu ~ + ~ • ~ ~ . - ~ J 1M. IM. ' ~ 'j - ' - ~ ' tO ~ ~ Ot ~rOltt~rn+lD DAi[ ~~a.r.. w, riOVt MO IN11MT OCiV~~EO ww4 nwn ~an ~ w ~ut M, nu. ~ ~ ~ ~ . i - • ~ ~ . - ' . i0~ _ ~ - - _ !p ~ . . . . - ~ M. 7M. ' - - . . ~ : • ~ . _ i?WtT wi M~OitR KME 0? NJUty ~t rya. ?.e.. srrn, ~.ewe+. _?OCwtiON ~ uue+ a a.i~. !M_. en* w a..e, a•w ~ _ _ ' 1 fMOti ~ef O~ wOl ~Kt hp_, ~fC- f fIK.Mf l ~ - N 0 . - . ~ C~[fRlCwitON- .aww sar e~r .~owa rw u~ Wt Mr wr/M~ MM ON ~ w/ow ~M ~rt.r ~ aarK OCCU~etO n+~ ?..u, w ou - - i ? ~ ~ 1' t iMTSK1~Ni Q TO rd~111 Mi HY Wr! YN~ ~M. ~wO1M~ Wf~, ~wo, q fv Ntt ~ . { ~ ? ~ ~ - 71L NC1?~C ?W~ v~ ~O ~ ~ ~ ~ - OI r~ [rqrilPG[. G:+t . 10-70-73 k. 10-,0~ ~II. I11. M.iOMGwSfJI3LilD. . i ~ : i : ~ - - CEtTIF1CwTqN-MEO~CwL L1MW~ER OR O+G~ER: a. *w ?asq w nr ww w ~w~ eaee~w wa ~eu , . ! WM~tOM p Ri! /0R INVI/Ot PV ~!!~W bOw. M q? pN,OM. _ - rOMiM qt ?iM ~qy~ . y 12~tw OCM~lO O~ M NR w MM ~D br 4VlfYt iLf1~. ' . i.- j , Tt~ ~ .Fl jjf - : . . ~ i GERrii~Ell-NAMf ~mt p?wrn S ae p nne w E S+G+tFD ~+a~w. wi, rw~ - f Melvin wo ~ :k._10/15%73 ~ , i ~ _ MA\ A ~ !Y f - - 1T~tU O~ i.r. . w. <nt M wnw _ . st~*e [r . ~ : ~ - - t t)1. + _-i-~F i ; ~ S WRIAI. CRE4IATK)N. ~EAWYM-. . E~r oR CREAAATO~r-NAME _ _ - ~OG?tWN ~ un w wrr . sc.,~ - ~ : ""~~ati0cl - r~cr+oal CYeratox'itn?1 • ` , - ~ West Palm Beach Flar3cla ~ 0~ E ~.o.~r . ai ~ fiJt+Etu esOMf-NA~F ~txD a0D3ESS e~~,r+~ oa ~a.s. Mo., em w tor.., p~r~, iu ~ i ~ - :w ~~'x ~i 973 „~.BAIF~ FU~E2AI~ HCY~.9Q? N 7th S`i. Ft. Pierce ~14rida 3?450 ~ ~ Y. S. f612 ~~?+E ~Wu~cr f+rtt~tt • uGs ~AGN,~TUFr mrE ~.U~r[O ~r tOGwt t(G~iraai - ( t.r. ivto :A L-~' ~ ' ~ ' ~ cs~ ` :H. Octo'_~er 17 1973 ~ J u. , - j - - - ~ - , ~ ~ - : . - ~ . ~ , i.E A 6 R , - _ " f - : - ~ _ pa~~~ ~ ! - ~ " ~I~RK C~~CiJ~T ~0{t~T ` i h~raby as~tify tt~k tu be a trw ~nd c~xr~ect copY af ~fia Locai RECOHD Y~RlFt~4.,,.;,~,~,.,,~ _ ~ Re~istro~s reoord on fiie (n tfi~ St. Ltxt~ County E{~ttfi ~per~ - } - ~ 2 I ~k P~! f Z~ . •~...~~..r,. ~ , _ _ ! ment st fc~t p~er~c.. Fkxrds. _ - _ ~~i ' Z Y~ ; : _ , ; , ~ ~ , ~ , " ; :~~Ea _.nt~_ , _ • ~.~a~ ~m.y . d:. rat~ud s~at of the St. tutiA - ~ r : ' ~Ct~l',; ~'f/~•~ ; _ i County ~lealth Department is affixed.) ~]~i~~ - 's .•s~~:~~-.*, T,:,- i VEl.7 - . ~ ` ~ ~ fi ~°E ~ ; tr < is ~ . - ; ~ - N..D. MlLLER, M. D. + '~y'es - _ ~ - 3 4 ; ~ ` _ ry ~'rlealth t3ffEter b ! Rsgistrar - i . ; . - - _ ~ d d~0i;.•L'3 ~ I r- s, f. ~`,~5~,.. ; ..r~ . - } ~ C.t. D.~ut,? ~ou~~ aaann~? ~ ~ - ~ . _ _ -i•- ~~i1~2~)I~'_-. . . j . _ . ~ . ~ ~ . ~ . - , . - . . _ . } ' _ ~ • - ~ - _ . _ _ - . ' . - ' _ ~ . . - ~ ~ ~ _ B 00~ ~~Q - p~ ~ ~ _ ~ ~ti.J~'. i ' ~ ' _ - ' r ~ ~ . - • " _ ;