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HomeMy WebLinkAbout2746 ' t C c RY'`~ i~; ~'lE'. ~ i e-I ~ ~ ~ , , ~k}rdmtnl o~ ~~ea~l~~ •nd keha~d~ilaUvc tirr.icrs , • SPATE FILE NO. ~ _ ~ - ir.~~csio.v ~~r- rir:~i.iti . - F L O R I Xl ~ - 1T?E. OR /RINt iN ~~YO~~~`~•~~ RE3187RAR'O ~10. ~ ?t~liAN[NT INK pECE~SED-rtMat~•!" ;i~.; ~~oou ' i:.a~ ' SFx ~ _ DATE Of DEAM i .~oNiM; os:, 7e~e ~ SEE MA~i001 10! ~ , ~ QERTHA DOUGLAS ~ Female ~ June 10 1975 RAC': rHn~, Nt6~, .arle~.~w ~wo~~.+, AGE-:.~si uHDti ~~I~t u.+ott ~ Owi 0~?TE OF N[R: ~~oNn~, o.., ~p~JNTY Of OFA1M ~ ~ ' IIC [ 31lC:II 1 {I~MD.t~ 1'aatSl ...rl-r p;Yy- V]• wfi~. T[~~ ~ - ~ , t`~t~i te 36 ~ ~ s, ' ~ + Au . 2~, 1938 liendry ~ CITY, iQWN, O:t IOGtT~ON Cf DE~tH u+:roe e~n ira~ri NOSPrt.~! nR CT?iE~t NStIT1JT1pN-NMtE ~~t ~ao~ ~N s?ri[a, e~.t s~ae~ r.:+r ~uwr_ ~ . ~ SIlCIIT ~IS O~ M~ ; _ ;r~ ~ Clewi;~con Yes ~ Hendr Ge?~~r~a~ N~s ita~ D;O.A~ ; , _ . ' : S'•ATE C~ ~1~TN ~ u:~. v.s s Ti2:'~ OF Wliti rOUt:(RY ~ h~4filE0, i:iYE.: h:lk~~EQ !Ctr~~'.T,C Sf~U~ c i~- evu[. oi°. ~•~o:H ••sa- ~ ; ~ ~ ^ COV.:it~ : ? ` ~j : t71~(O: 4 1 +fK:A 1 . t~ . Vil':1Ct:Y~:r: ~ l. i1~.~vi" 1"a A U~J./i~c ' 12 t~arrie~ ~~i~~il~e Ooug3as J . erw!x ~+C:~:~~ ` 'i~KO. i'Y'.: ~ SECUR(TY Mt:~!;i~ , USVAL OCCUPAT10tv ~e~re euVO o~ vre:: oe«e »:~we ~os, o-"~x4-~ e~ : ~..~ss oz ~7~F~USTtY ~ { oe:w:a , j. otaire ure, ae. :r etr~~w ~ . . ' L60-6Q-8G~7 Housewi fe ~ Own Home ~ ~ ; npoe»cc ._:o.; , ~°"'s1'°". 4fSiDENCE-SfAiE , COUNTr C+TY, iOwN, OR IOC~T10t+ ~~?~oe em ir.m STREET Ae+D NUM.fR : R~ ~ueun ~e~ o~ no~ - ~ ~ : ~w Fl ori ua ~uHendrv ~k C1 ewi ston ~~o Rou~e # i.~o:c- 80 fA.*HER-N4M:. ~i~st .uoat us? MOTr1ER-MAlDfN tJAA4E ms~ - .a~+p~e usr ; . ti~ 7-.?3"r: _ i ' ~ ~ ~ , . - Isreal - ~reen "1ei ton ~Janc;y . - Oeloact~ • : f . i rxo+u+nrat-nu~ ' MAKIMG ~,nDRESS ~sn[e~ o~ ~.i.o. wo., un o~ ~owN, sr~a. i~? r M rch~e Jou las-Husband F Rou~~e ~ 1 Qox 80-C1 ewi s ton~ F1 ori da 33440 _ ~ _ ! ~r. . ,._...._..._:_.__-._...s;.....c;.,. :x. ~ . w.cou+e uvu - ~ /J~'J~I - ~ ~~/f/ - i - I _ ~~,/!'/y2Gs.~- J ' ~ i . . ~ ~ - ; ~ ~ ~ Cowo~noNf, u ~n+, ~ / : ~ -~rx~cM o~re ~~se ro (6) i~ jl~,-t LG~- /J (~a_! 1?~j/Jzr 1 . - ~r.toi•r~ t.auie io~, an to. oe ~s w co«staue.~cE os: ~ sranMO tne uMOV- _ ~ 171M0 CaVf! L1ft . . ~ . _ ~ . ~ " - . . ~ - f _ ?ARi q. OTHER SIGNifICANi CONDR~ONS: ea+wnor~s cartn~unNe ro ot.rw ~ur ~or nurto ro uuse errtw ~M ren ~ io~ - IF rES we~t nMO~~at ea+- ; _ ~ . ~ ITtf Ot MCI ~Ot~[O IM D(1lWIMtl10 GYS! i ~ p 0lAiM i' (((hhh~~~pppaaabbb.yyy ~w No ~ ~ ~CU A ~ ~~TM, w~. Tt•~ ~ ~~QPPrOX NOW IN1U0.T OCCURRED ~ i~e~ .~nra or ~N,vn i~ r•~r ~ w r.n u, mr ~ NOiMl7 O! U1~D~TEWIMED _ ' • M. Automobi 1 e Acci dent ~ ' f IHJVRY AT WpR1C KACE Of hJVRY .r aorc, ..u., sne[i, r.cro~., ~p~~~ , snert o~ ~.~.o. No., em o~ rowK, si~n ~ ~ - 1 WQC~I/ rtf W MOI ORK! MDG., l?C. ISRCtF11 - A•- ~ H' 3 i l So h I n r e ti on of SR 78&74-G d Co ~ . ~ ~~~fK,N'~- YOMiN - OA~ tIV YONM D4\ TEA~ - ~O ldSi S~M MWIpH Alfl/~ ON ~ aotoro wr .x~. TMc oe~iN occvu[o Ai DI~ ~lA(t~ ~N Alf ~ _ ?NYfK~Ar~rt~rwio n~c - TO i~oNrN 0~1 RA1 W6f ~/iH DlAM. tH0(MI DATl~ Nq, f0 ME M{t ~ d rr aqrrtleql, pu[ fl~ o[ce~sto r~or t11. ~ tlc. 211. tb. M. ~o me wntn~ u?np. g C~TIFIUTION-1~AEDICAI ExAhuNFR CY~ CORONER: o.~ r~[ ~.,s~s d u.e r+0ut O~ O(•rn rre arcea~: w•s ~~o.~ov~+ceo oc~u ~ _ tuw~una+ or w~e qor ~,.o/w nrt a.v[snc•noM, ~N r. ar~a.., ..a+rn o~~ ~+out . 4[wTM OCCUMlD ON M O~Ti ~nD DN! i0 fnE UYSEISI ST~fFD. O: 45 - a~ ~ ' M tf1. CER1iF1ER-NAMf ~rrn oe ra~Nn S~GNAi E ~ OfGfE! q i~RE DA E SIGNED ~.w~+n~, o•r, ~w~ ~ ~ t~. ± , ~~l 0, 1975 ~ ~ j MAAMG wDDRESS- CfR11FIFR snier o~ ~ r o. u. un w ~ow,+ r.n r ~y P. 0. Box 1Q85 C1 e~~ri s ton F 1 ori ~a 334~0 ~ ~ ~UR1J?l. CRfMATfON. RfMOVAI CfwtETERY OR CREMATORT-NA.ttF . lOUT10N urv o~ ipwx si,~rE ~ ~ s~tan ~ . e;,o. ~I~r?r_~- ~~r Ui ll ~?^~ct !~nR{/~r~~ (~nrp~t C~ =?n _ - - : r Di ~~•~a . . . _ - - - - - ' , . U.:Tc t.aC~rtw, Ocr, t4~[~ ~~`Jr~[°R.. -~C: ~+i..~.i AfYJ RL'J.::5.5 ~::eFt. Ot :.i L. e+J., 4~. e= rorK, SratE, ter i-- ~w 'une 14 75 ~Rattison F neral Home-~138 E.Su arland Hw .Clewiston, Florida 3344Ci REV. 19TC f DtR pR- i E ~ REGISTRAR- AiURf DATE RECEIVED t~ IOCAI, REGISTRAt f LFD 1264 .~<<~ . :w ~9~~ ~ 1 nelceb~ ee~r,ti.~y ~'he a6ove ~0 6e a~iuce and co~vicec.t cop~ o~ xhe L~?c.a.E Reg-i.a~an'a ~ - " heeo~.d on 6-i.2e .~n ~he Nenc{~cy Cour~;ty Nea.P,th ~epa~men,t cr.t LaBe.~Ce, F.e.ohu,da. . ~ iW~n.~rtg: No.t vicel,i.d un.ee~3 na.t.~e.d 4e.a.P o6 ~'he Kendtt~ Cauwty HQa,Zt~i ~epa/c,~inen,t ~.d ~ a6~~-xQd.l ..:~~~;:'`;~~~s, - - DA.t ~ ~ r! ~~1~ { ~ ~p - , - - t e' . . ~ : ti~i , ~ 1~i~t~tA. i ° - - - • i~. ~ i~~ s . - ~ ~ ; ~ . - ~Q t~ # ~ ~ - . ~ ~ 1: , s. ; i`~: ~K~4~ . ~ WOIi . H . ~ - - ' _ '~~=y~. • ~ ~ Y !t! ~...s~.~ ~.~Ceh and Loca~ Reg,i,b~'icc~ ~ ~ . ' a . • - . . j ' ° ` ' • ' ' I. r. . i _ . . 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