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HomeMy WebLinkAbout2830 . ~ - - ~1'~.Q~,; } CERTIFICATE OF DEATH ' • ; ~ ~ ` Drpr+.~eM .1 H..46 .nd R~{~.I~In.uR G..~e. *rwT~ FILR NO. ' ~ 1 ~ !M~'I~KX"! OF HFi~ITll - 283 ' i t tr?t, o¦ rnHt iN F 1. O R I D A M~IrANONt INII ~•w~µ~~• ~ RCOIiT11A11'• NO. ' ~ ~ SEI WPIOOI F01 ~~SiO-NM~t nef~ rwa~ utt StX DA Of OEA ~•Oatw, e~r, n~~~ , ~ ; .n?tbaa.s , - ~ - RE~'YtVOIDS t Male ~ M.~v 16, . 1975 ; ' ~ ~ RACf .,un, Mron. ~w1~K~_tiNUw, AGt-us~ w~oe~ ~ re.~ w±on ~ o.~i DAiE Of ~IRi11 ~.a+ro, w~. C01M~~ O~ DEAM ' ? : ; ~ t~fiite „r°`. r ` ~ ch 10,1905 St. Iucie ` ~ ~ ~ 6b02 m~, t'owf+, WibC~t A M Miwi an ~Wm ?~osrrt~l O+t O:„H iON-t+ ~r wr i« em~~. on~ ~ner u~ .w~~ i ~ # , ~nt~n ~es oi Mo ~ ; , For~ Pieroe Yes Ft. Pierve Man~rial Hospita]. : ; STATE Of N~M ~ r Mot e~ a., N.n~ UtIZEN O~ WMai COUNTRY W?RRfEO, NEVER MAltlED, . itlRVIVlJO SKxlSE i v ww, ~M 4,~M ,w~ ~ ~ • ~w.~..~re~.n ~ Ohio USA ,~~tZ'~l~~o~.r.c.,~ u. MiIY Ei. HAyE'3 - ~ i rrfq OKt•]16 . 1 Uvl~. 1r Ol4M iOCIK SECV!(Tlf NUAYf~ VSl1Al OCCWAI~ON ~are ae+o o~ ~wc ew~ ounwo ron p KNp p WSMIE$S p~ 1lOUS1R1f , 1Mf„MWM.OM . . ; 285-10-9392 ~•~•~•pMi~~wrig~~ , ~ackwell ~~YOfNC! NqM RESIOENCE-SiAfE COVMTY CRY, IOWN, OR LOCAIION MMN <nr trans STRFEt AND MUM1~f ' ! ~ wcut rt W w0 t ~ Florici~ ~p St. Lucie .,k_ Fo~rt Pierce I~O 1504 Jw-~nita Av~nue ~ . ~ - ?ATMfR-NAMf ~~M~ ~ax~ ust MOT?1Et-MAIOfN H~ME ~NS~ wMU wr ' ' ~ _ ~ p'{,,,.,~ D - 7 ~?''~,.,~~y,~,, _ ° . IS 1~.LL:iYILI.I D• - ~~d$ H.. '-'R~1' l+• L7~111~• • K4l ~ ; - 11'!I'ORAIANi-H{ME MAIMC AODRESS 1l~ff~t W w0.~ C/M O~ tO~w, ~/~7~, tM1 ~ . : B . ~ lds ~ 1504 Ju~nit,~ Ave. , Ft. Pieroe, Flarida 33450 ~ ; _ DEAM WAS GUSEO {Y~ (EHiE! OMY ONf fAUSf KR IRIE !O! (e~ (r), Atrp ~i ' : n ` ~ [V - p rl D~~ •l'1 • . ; ~fl'~'~!M OMHi n1~ MA1M i i , • . i~~ ~jl~=/NC=~'A~'/1N G'/~ ~~L~ - - _ , ~ " . M . 4 A~ / ~ i cO~nn~owt •~n, ~ ~-1 ~ EF - ~roR/~ x ~ ~ ~ ww~tM O~~F ~~1t t0 ~ /~'~~~5 ~~~~~.~"~7~ ~rL'/? ~v ' , ~Mr~el~t~ c~vt/ ~of. ~ • ~t~tIMO iw! tlM~1~- ~ « ~1 i C[~Ny~py~.~(! d: . ~ V . ltIMO C~ON l~lt ' ' c~~ ~'lJ'/~.SHC'~i~" I'YOU/~'D D~ t /~_F -r 1h~ ~ /~nis~,E ' , . . ~ ~ ~1 ?Afi p. OTNEt SIC~H1i1CMiT CON0f110NS~ tw+e~no-n co-nrovn.q ~o oe~n~ an Mot ~nine ro c.vse o~rN ~M r~rr ~~a ~ AV1~T N YES rt?! lIM~IMO~ ~OK• . . ~a ~ni o~ w~ Nee.» ~w er[tnr~~w.o uwr j : a ~e•~r , ~ i i _ iw. ~ : 1?~~6n~ IA M. 1 b[ 1~A I~Wtw.M~,ft~~l NOII! ~ 3 NorKi , Ol ~7wtlEtrmFO MOW INJUtY 04CUfREC ~ ~~r~t~ w~nm ~Mnn ~N ~~rt ~ d r~w n, nw i ; E ' ~ ~'`""y~ , - , l ,,:t r~rr.i~.~.s~; y ,~~~'s c.c~~~~rc 4 ~~,Y ; ~ ~ t _"~_L/11~~J~I i11 I f- 1.~~ ~ I / M. tw. rt^ > ' ; IMAl~Y Ai WORK KACE Of NJU~Y ~t wo+e. r~~r, 1nt1t, IK!p7. ~ . 7 r tOC~n xa ~ inu~ w~.r.o. .ro.. un oa r.~+, a.R ~~si~;OT ~//M S l=.t ~ ~ 1~?K~A 7!1 01 MOI yfl(! KCO..I~C. IfRCtR~ ~ - ; ~ ~ _ ~ / ~ c ~ Y ~~~~~n•~ ; ~ r. r= - f_ l - ~ GERiYK~S~O?~- .wn. ~a~ n.~ .~o..~ ~.i .tu •w u~r s~r Mw/Nn ,.v+~e o~ ~ aoioe .o, .+r. w~r oe~rM occweeo s~e ~un, a+ w~t ~ ?IITlKUM: ~ TO >p~M a~ AV 1~R1MDt0 Mf ?OOT ~flti MAM. I1~OM1 ~ N1K~ t1A. ID 11~ ~(lt ~ ti 1t~ o~ttasro rro. f4 . fl.. n or r~ ~ripw~teot, sN i ( _ CERTIiIGt~ON-MEDKAI EUMMr(t pR COe01a[~- a+ +w sain p n~ ii/ !N. ~ M, ro nw cMy~cs~ f~~m. ~ ; ~I~uo~~~WN d Mf WQt aw0/01 M Mrtf*~G?np.r. rN rs pr~p.1. ~OV! d M~fw ~t NClRM1 ~ry /~ybVKt~ M~~ . . W.n~ ottvwto aa~y h _ ~ l ranr wr n.~ MpM i ~ ~J ~MD?}L~~~~l~nt~'~9 ~ ~M rn ;SS G CERnf~Ef-?uME mn w m.~ri A etutr w u A ~CVrEO ~w.++~. e.., rw i ' ~ ~H ' , c~ 1 i. ~ a ~ ~ u ~a , . C.~.C.._. _L_ .~'~c-~ -.z o ~ t : ~ MARNQ AL+DRESS CE~Irt~[I si~[~~ ~.~.e. . cm w ur,. ~ _ : c _ ~ na r~ ; i ~ ~ L. ~ ~ 1- ~ ~t~~ ~i ~ ~ ~URIAI. CREAUTlON. REMpVAI CfMETEl7 OR CRE4NTO~Y-NAME lQ(/~~IOW . C~n p~ ~prr~ s . ~ t?~Un ~ ~utt _ ; ,a Rcinoval-Burial i~wton Falls Ohio ' ~ , _ ~ - OAtE ~.o.nw, o•r, n.~f fU~+E~~l H F-NAM( AND AOpR(SS ~~r~in o~ ~ r.s. ..o., cm d ~o~~, s~~r~, tir ~ ~ ; ,y May~18 :1975 :H FUt~I~RAL ~K~'1E 90 St. ~`t. Pier~e Florida 33450 ~ ~ ; Y. S. /612 ~~~+~t bMECTC//,~j~J ~EC,~ AR-3K,N/1 ~ D~R ![CEn[D ~i IOtY lfG~S/~~t ~ i ~ R~v.19I0 i~;-~`. _ l ri, ' f- ~ Ma 20 ~975 4 ~ ' ~ E4 AMD~E C6Rp~ ~ ; s i , . ~~L{iClf COb_~ITY ?LA. ; ~ ~ ltOCER PO{TRAS - . . ~ ; ~ h~tby o~rtify tfih ro b~ a trw ~nd corr~ o~py of 1M LosaCLERK CfRCUl1 ~OUitT- ~ ~ ~ ` ' Rpi~trars reoord on fi1e in tfi~ St. l~ck CounH H~elti~ D~E~COR~ YERIi'IEO.,....,r.... . U •V fr'.rrtt N Foti PiNte, flortda. ~y' ;';l - ' i e f ~ ~ , ' (Wstning: Not velid unless ra~sed ieal ~f thv S~. luci~ f~~ ~/Vy/'~~" i'•., ~ j Cpunty HeaHh Oepartmer+t is affixed.) ~ i- • , " / , :,L ~ ~3~.~ ~ - _ . ' , - . . ~ ; f + . "f•~ .J . y'. _ ~ N. D. MIIIER, M. 0. ! ~ Coun~t ~H~ith Offic~r i tACSy, Rpi~har . . ~ - Y~~ . _ ~ . 1_ i ~ ' ~ t9~1~ . f _ , -i ~ , i~ .~Il~ it I ~ S- ~ 7 ~ " i.~~n • ~-^~f.~.,,~~_ C~ . , . . t 1 D~A~ DeQv~r Locd R~ohn.r _ . ! s . . ~ i . . ~ 3 ~ . , ~ ~ ~ 1- - . ~ l - _ - _ ~ ' aoox Z~~ PAGE z~~~ - - - ~ - r - ~ ~ ~ _ _ ~ ~ - . - :