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HomeMy WebLinkAbout0924 . . i ; ~a~~'~~.~ , ~ ~ f ~ , cERT1FICATE OF nEA7H • • ~ ~ . ~tr~iatnl ol ~ k~~11~ ~nd Kr~~+i)11~ilre ~trrkt~ ~'TA7t FIL[ NO. ~ ~ . . IN\~ISMRV Ik IIi.VJI{ F L O R I D A - . . lYlE. O~ IlINI IH ~ ~"°'~~~u'~•~~ ! ~ rt~MANIMi INK REGI#TRAII ! NO 21~ . SEf M:~1D~001 i91 ~GEASEO-HAMF r~~t~ +~wo~e t~~~ SE7I DA1E Ot DfATN 1~OMIM, 0~~~ .1~~ ~ t ~ ' CI-IARLFS DIt~LS SEVICR ~ b`?l~L,~ A x3.1 5 1975 ' ~ < ~~E fMIT~~ M(O~O~ ~Y~~1(~M INO~~M~ AGE~I~S~ UNOi~ ~ t~~~ VNOI~ 1 O~~ OATE Of ~1RM Iry,rrw, Oii, COUNIY ~f DEA1H ~ . ' ' I~C 1 L~IC11\ ~ . ~~~iMp~t ItlL~sl rp T-_~~- TI~~ 1 . . • . ~ D~~1 + M~y~~ ~ 4M . + . c ~ ~ l~mita ~ 91 H ~ Jan. 3,1834 Sain~ LuciQ 6UOZ «T~. 101NN, Of IOCAl10N pi p[A1M w~w1 c~** l~+~n MpSMiPI OR O'HEt NSIIiUT10N-NUNf ~n w01 n~ IinN~, G~rl 1~n1~ ~~+0 ww~l~ 1 ~ s?eun .~i o~ »o _ • n rort Piezce Yes Fort Pi.erca riemorial I~tosptial~ ~ . . ' STtTE Of i~~lfH ~~r wo~ rar~ ~ITIIEN p vVHAi CqlnTlY M~tRi O, NE~ER MARR~EO, StM~rvNG SrOUSf w~~~ o~~ r,wM w~re ~ t • _ •,aw.n.I wKipWfO.DIVORCED~smr.~ • usv.~ asw~~ce ~ ~tissouri ' LTSA - - . r~arried - Lucia_ ~~JeUster . . € " .wnuice•a~ --1-- _ une r at+u SOCIe,t SECUtIfY NUM~Et ~ - tUSU~I OCCU1Allpr~ r'ur~ ~wo o~ +cn op..~ pvsi.ro +of~ or KfNO Of WSWESS OR INDUSitr - . OCCVN/O IN j ~oa»a ~ne n r~~~no ~ . _ . . ~ ~~».ry~~~, aM 487-07-8686 Taxes ~ ~ State ot Missouri .«~e~.~~ .~~an ~K ~ atiu~t~ow. RFSIDENC~-Sf~Tf ~tOUNtr ~ CtTY. tONN. (NF tOCahON ~ ~'~s'oe cm ~~+n~ SltEft IU+D NUM~f!'-~-- ~~.ecu. ,~f o~ ..o~ ~ ~N Fiorida St. Lucie rort Pierce YQS 6~1 So. 6th Stree~ ~ iAiH~R-NIM( rr~s~ rrootl _ i~s~ MOIHfR-hU~DfN IJAMf ~nS~ ~•cw~l utr ~ ' `i ~ . Charles Sevier Cmma Dines ~ _ IHiO~M/,NT--NAFtE - ~t~?V~('i AppRESS ~stnt~ o~ o. No c~*. o~ ~c~~. fr,n. tw~ . ~ Luci.a W. SeviQr ~n 611-So. 6th St. F~. PiexcQ rla. 33~50 . ~ S ?~~I 1 pEAM W1S CAUSEO ~Y: . . ~EMffR Ot1lY OHE C~USE Ift lWE fOi (o). (61. AND (tl: •r~~oi~rs ~r+ ~~u ' ~ + ~ . - .rrlO~tA C~VSt . . ' flrrttM ONSII ~wo OI~IM ~ _ ~ . , . : ~ . ~a~ ~ ' C~~'-G -t., c' r : ~ : ..~-':y. 6,T?0: biT , "uar ~ - ~ to.ro~~~o~f. _ ' - / _ ~ ~ ~ - ~ . _ ~ ..~.r aa.~ .~ft r.~ fez.' "l~! / / -'I ` ~ J' i r-~/'C: ~ ~ `~L f--- ~r~eo„~~ c•cs~ t a~ lr. _~L~s_._.__~. f~•t~wa ~MI vw'vii o.% ~(~~nt •S : t(+rslOUl~+[t or- t _ ~ ~ _ ~.~ra c.•ifr ~.sr . ' ~ i i - - _ - _ - _ : ~ ?A~f p niHE~ SK~rvtflC~NT f.pf~tDl~lprlS ca.o~~~ws co..~n~~m-w • --r ~i--'- ~ l- . . o a~,.. ~n r.Ot H~~~lD ro CaVH G~~N tw I~~~ ~~o~ ~~UTU15r rF YFS r~~i r~ro~~cs cw- ! ~ 7 '~It d~O~ l~O~~~O ~M OI11~~~MINO C~V?! ~ - J '`~t.1yf L'1 ~ ~r~.~~...."7 . 1 4010141M , S . ~ . ~ {t. Mb1Y1 4CGLF~'~.:J'CeL! 01"'rp~1Zf~~M1URY r,.owiw, rr~~~ 'HOUR _ .Ih~~ ilq ~ . ~ N~~OoMecK~dF: Ot NKMTffM~?fiO ; • i ~HOW IN/UfY OCCUR~fO ~ ~~+*~t "~~ry+h ~u~. ra~+ ~ p~ ~~n ~re~ ~ ~ . 70e ~ - . _ _ . . 's ::0~ 'X' N'ip ~ ~l~N~r ~t vvA~t -'i.~CE Of u~~wv.~ .o.e. s.n~~, r.r.a,. ~(~C~t~Or~ . sn~~~ o~ o NO . C111 l7l IU~M. ~ £ ~ tincn. ~n ..o ~ ~o.~..~ •w. e•r ~ ti.evn ~ ~ . ?M . ~ 1 i!~ ~ ~ " ~ CE~ivK~TK~?+- .~o.a. r•• .eu j .a.,~. o.. ,.u• ...e us~ s... ~rn.~ am~ o~ oro~o~o•.~,~ n,!. ~ ~ . - /N131CI1N~ ' ~ ..o~.,~ oa, ~oo, u~n r..•~ tay: oetua~to n.~ n~te. w 1 ~ :.n~.+art• rN, 10 ~ Y1 o..+, ...a. ~o na Msr ~ 9t• r~e~.••o .~e+ _ . r <i~ . aw+~eoei o,e . ~.966---1'-„ _presen~; t~, -~-2~ did ~t.5 • 45 M .o..~ ~.~u,,,,,..,o ~ ~ CEl*NICAiKN~--~.~EpKwi Et~~' r~FR Oa C01'O~+El~ o~ r~r ~,sn a iw r. ' • . Ia~rnv~nO~•v tw! qD• a..[. rw r~.fs••:~•v:v, ~v (+~n~. r.ua n~ q.rN 1 1 CtCIDI.at ~r~s r~r.r.•...«lo c~., . 3~ ~ p(~rw n(CWtfC b+ n.l [~r O . { rp.~tw D~~ . • : _ ~ ..an o~n m.n •.•n~~~, s~•no ~ ~r. - - ~ ' ~5-='-P._"':: , , _ S : 45 p. „ - ~ , CEtryriE~_ri~M[ •n-~ o. S~ i~~i..E S ~ . . - j c~~'~ ~ .s ~ -'n,rr s~cHen o.. . - - < »._,~hn_N. Sims,--I~,D..--PA ~h •.t.-' ~`i -4:.;-. r;'~'' :;,•-_4-9,75,_~_ ~ , - _ - ~ - ~t~ ~:~,o:~ -1 - - _ ~A"~GA~~tE~~~~~~~T. 6th Street ~ Fort Pierce, Florida'~: 33450 • ~ 1 - - 6i~~~~l. C~tEM~t~pr.. :(NO/A CFMETfII QR Ci[M1TOoY -~/A!~I :iQ~AfiQN ~•~~t 1;rt,~r.. . r~ . . 7~~ _ Buari.al ~~~T Ft . Pierce ~ Ceme~er 't~~ Ft . Pierce Fl.orida - ~ 4 y-- i---w - - , OLTE ...o-.•r, w. ~ ~ri;~~fo~~ HOMF _ ~ILA~F ~~J(I ICIi)if ST ~ s.~~tr ce r r - - _ . . . ~ e o, t~rr o~ +o+v, sr.+r. r~. ~ - ~ r H ~A ' 1 8, 7 S Y a t e s F u n e r a 7. i o; n e B o x 7 7 7 ~ r~. P i e r c e, r l 3 3 4 i 0 } ~ Y. S. /E!7 ~lF~fletO F~ -SrG ~I~ - RlV. 1910 - ~y~ - ofG,Sf~Ai--S~G+l~fUfF Q~tE ~tCl~vEC lpC~l ~tG~Stl~f i1• t~~ ril 18 ~.975 ~ . ~ . ' ~ - . , - . ~ - - = 1~~bY cKtify this to ba a trw ~nd corr~ct copy of ths f~ou~+; f~lEb il1~f~COR~£0 ihqtftro~s recard on file ~n th~ St. l~xie Gaunty Ft~etth Oo{~ert- ST.LliCi£ C~i~1~ ftA. - , b I IT~M~f •t FoA Pi~?te. Fl~tide. ROGE~ `s4~ ~!!~S ' j11: ~ Y f~. Ci.EF~+~ C;TtC~iT C4UR1 y~_ 'U ~ arni Net velid unless raised seal ~f tha SI. luci~ P.F.C~ RD Yr~ fif0~~....r. s~~d~~ - f. ~ ^y~ ,s . r Covnry Haa~th Department is offixod.) ~ ~ ~ - - ~ .~i ~ ~ ~9 ~ - . - - - . _ ~ N. D. MIIIER, M. d. - ~ , ~ ` ~ ; 'Gou~l+,~y H~ith Officsr b L~. Rc~~sfnr (~i~~~C . `~!1 ~ • . ~ _ - ~ j ~ _ f`~i.~ ai _ ' 1 ~i~ ~ . ~ 1 ' ~ _ ~ . i~~,~-~ ~ - 7'-/ ~ - ~ , C-~ _ - ~ ~ ` i"~ - - ~ p~~ Drpury l,oui R~o~stret - ~ . _ _ t i ~ ~ ' 60DR ~AGf ~ - - - . ~ - - r : . . . - ' . ' . . ~ ( • ~ ~ ' i . ~ . _ ~ ~ ' r ; • . , : . . _ _ " - _ . - . ~ ~ ~ ~ " ' t