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HomeMy WebLinkAbout2831 • i , OEPARTMENT OF HEALTN AND REHABIUTATIVE SEfiVIC[S S7ATE 0: FLOf~IDA ~ ~ DIVISION OF HEAITH - . _ ~ _ Al~chua Cc~unty E-4ealth Department ~ ~ j Teteplione (904) 378•5321 P. O. Box 1327, Gainesvitle, Florida 326Q2 . ~ . ~ ~ CERTIFtCATE O~ DEATH . ~ ~~~~.etl~~x~il a.F ~l.•a~.h and Ra{~~~~~~italive C•r~iii~ 57AT6 FIL~ ~;0. ~ ~~~~i-:~,~v c~F ti-..~.,H F I.O R I D k , ~ j.~; ~a.ti~ ~,,v ~ •~•?,...:c?.~r...ar.nsncs . . _ ~ REGISTpAR•5 li0. . F: t!d3'ii`1~ 1t:Y ~~x ~ DAiE Oi C:Aiit ~ rptitw, 7~r, ~ :,_fF~~EJ-r~.u,c r.~sr -r~~~~t ia:~ ; __c 4~,:?_i.( i?2 ~ ~ Cnarles W Kerste~i ,~!ale ~ t~ia 1fi.1975 ~ CaCE w»~~t, wfew, +..a~~c•N ~..o~~~, AGE-us~ u~~e• ~*u~ u.ce. ~ o+• DAiE Of BiiT3+ ~..o,.n., aar, ~pe~viY QF ~iAfH ` - 1 S~tC~~~ 1 ' t~lMDa• t[a~Sl Y(iS.(1 _~r pA~y 1 N~~~! tY. T}J~i 1 . . , Nn i te = s. 5~ s~~___~-~`` Y '~'~aY 9.1319 Al :~chu~ ~ Ct:Y, 10+~N, O~t LCGTiOV OF C~AM ~~Lae e.n u..~n F.OSa}fAt QR OiHF,t L'r51iiUTfOri-:iU~E t~i w~ [~:.+e~, e.vt s:~tti ~..o .~~..aea . ~ ~ ' S+K1~T rtS O~ n0 ~ 11-~ 4 _ . ' „ Gainesville Yes Shands Teac~iny Nc~s ital T - • p S:~It QF d!~tJ1i i:r r~or ~r u.s.• ,~~Ye CiRZEN OF Wi1Af COtiNi~Y MAi~i_O, tiEV~Z ~,72i[P, SUZVN~VG S~OUSE w~.t. eyt w.~~;•+ .+..,.e: ~ ccu.+~ar~ W. nE~. C; 07tED tvrcw~ ~ , l~isconsin ,.U~ited Stat~s ~~ar~i~d ~,;_~lari~n~ Gress ~ S~?CI.~I ScCUicliY tv~.r+dcR~ USUAI OC~U?A«Ot{ ~avr e~MO o~ wo~~ no~.e e•:+~.. +.oar or XtND OF EUStlrzSS 02 1`MUSTRf T~------`-~---~~ ; . , oa.~., t•!t r~e ~ •••.s.~i :-S=: ~ ~ 3~:2-;0- Jd$$ ~i sao~ ed-U:iobc~ i nab 1 e _ - ~ ~ ~t in. - - [EStU'NCE-SfAf: ` COUNiY ` CITY, TO`M7, 42 IGCAfIG?i ~s~~t ce:r iwns~Sf~7EE~ AND NU•vee~----- ~ " - ~srtt~~r r[s Ct ~.V~~ . - . . ~ _ } . Fiorida :~y St L~tie ~ ,,,.~~Ft Pierce i++ Yes ~t. 11:~0 ?~sssei l t_. g ~ Fai1ER-r:.v~F i~~sr N:e~:~ - usr M(lih'3 -MUl7rM N3Mi etis~ r.~:,i! V.;: ~ ~ +s - C?rt • ' Kersten (~s. Li 11 ian ~ - M.. ck~?. th ~ - ~n:-O~w~ti? .~n+e r{?~ 1 Cel~GO f'C~5 ~~:.~LIM~s .1Ou:LSi 131~!!T Oi ~ r.o. ..o , e,n o+ i~r:., s~.:r, e..i j/_O 1 4J ~ . ~ ~~~'-ri'_~~- - ~ ~n .Shands 7ea~hin4 Ho~~i *al ~~i ~~svi 1 le Flori~!~ ~ Ts..Q~ 1. C;ATF1 ~vA VaED St: E:+tFi e141Y GNe C~'v5E PE? [Ir1E fC,i ;o. .~~+c-:~-. ,~n:e,.- 3 t 7 r~1. ~t:D (rp te:.,re. o..;:, .,.o „ ~o~.~ ~IL AM EC~~ - : c'~ Hvr . i r- ' -~r.a s. aT.lUCIf Cq MTY f~ i ~ ~a.~.-s . tp.~r~~.R. o:: - Ct K I C~ 1~ r - «,.o~.~o.,~: RECOR VER!ti r.t..~~ . ~ , ~ 1~M1~P (~lY! ..,t ty~ - U~~er i n~r_ay Qbs t ruct i ~n ~ ~ - ~ ~ ( ~~~co~~r~ ~ wvsE rc~, o~t ro, o+ as + co+stw~«ct or: ~ - ~ . : v~~t.. Jw ~ 1 3~ i'~' - _ - <<~ Carci no~na of Tnyroid-__ - , ~ iaqi !1_ OiH:R S:GNtfK.LVi ~Oti0i7ION5+ ee+ana+s eo.snwn.w3 To o!,n. s~r r.or ~ee~re~ :o ewusF errn r.. ~a~i ~ ro~ A'vi0?SY 1: t ES ~.+ere ~e~;,~+et ( ' _ . IllS O\ HOI SIJ}lsJ Iv C!f!l.~:r~N+t~ C' . - ~ Uf ps,~,:`M - ~s. Pi0 n~. 3 1+-=b~'~h~l KCt~Cttt, S:;~CiO= Ot JATE Of 1NJl']'/ l?0.`~iM. N7~ 1[Atl F~~R . h~W fN1U,tY OCCUZR~D ~[vtt~ n~w~e or ~~,~utr saar ~ oa r.ar r•tr la ~ 3 F:'4:b~=; 03 ti`~OFTFR~+1NC0 - 1`y+<.71 - - - ' ii 7.0 1:! A+ iY ~ 1'::URY /1~ W02•. FU~E CF I.YJ4~T,r.w-~+r, rw~.., S:rtt, r.cr~aT, t~^,:..~ OtJ ~»~!t~ oa ~.r.o. r+~., c~:r o~ r~~.n, _r.rti '--3 ~T.•~trT tfS Ot r+:)t J~7tCt ~:oG.,tTC_ /S)K!n1 . - - ~ Y:• ` 2'7 ~ 4 . ~E~~fiUT~~d~ rO1+fA DAY TE~f ~ Ir~nM . O~~ 7F~f Arip 41~ ~r~/Mf wll+! 0» ~ C:J/D~7 Mt Y~=v p~t 9tAtef OCLl:7?'il ine ~~uu~ py T r:~rs~uaH= TO o•• reu sxr .ne~ o:.n.. . ~~~~.'t^ ~t IF?~.3tf CavS, I..~ t~ ~.~_.s~o,.o., Jul y i973 t~t~y 15,197; ~~~T:aY ~ 5.1975 ~:z D i d 0315:=;:.~ z r: J~x;s;'S . , CE~ltFtCAi'C.v~?.:Ep:~~l EXA.u:N=R CR C020trfit- ov n.e ?.s.s e= r+t Y. ~r c• ~e.r~ r~r o=ciu..r .+~s rr~~.ax.cco oe.o ' - . Er,~..:n~r~eti o~ r~• sJOI ttiDlJ~ t.t ~!iYfSi.G~nO--~, r. erw~~-., - r.o..rr o•T r~.a r~.;a y- ~ Ct~iw CCCV1f~ py ML O~.F ?MO OU! ~O Tltt C~VSE~S1 5~~.1:p_ , _ _ ~ t'.i K,2Is . t:~TtHc~i-:7.V~~ ~nrt c?~~..n~ S~GVaf~iF ~ , oN:aEt o~ r.nc Ga?E S1C-?J~~ t~.:.+:r, u~. rc. t1 i cho~ as J. Cass i s i i'f . 0. f 1 . _ r~ ' i -..~s_~ ~.£~-a.~-z~- )1 :l~ - 1t1: ; 1 7 , H s;1~riG AD~J~f55-CF,~I:i~[~ ~ S•a~er ot 1 r D. i~rr n;.r yr?:t ~ t,~ . - r;: Shands Teacnir.o F:o,~~tel Gai:~>>~~illf',~lori~+3 32biC~ ~ - 2ux~Al. C~:t+~t:ON, fa'v(~~at CiIaETtRY Ot LR;!~ATO~Y-t:trrt t0~~T10:1 urr oa ro~v yt„7_ ~5..~~~r, Ft. Pierce ~'lo-rida~ Remo~; a 1 t:~ t:y tr.. Oai~ ~r v-.. - r_•a~ ~ FUVf~al HO~~E-NaMF Int~ ,e~7~~55 ~ sr:t!r a~ ~.s o_ Mo., trn oa r~w~ s.a:f, i~s ~ " ~t'ay -15, ~R75~ ,;,?~7ILLIA;LS-THO:~i~S FH 40a 1~I;..: t~tain St. , Gainesville Fia. • ~ _ _ O2_.c ~.tia: V= k_Gf5-74?-~S::.ws;L=" f; i ~wtE Z.c i~[u a_~~:5'~~~~y r= = 7.~ '-'~.l.i.t~r'.~ 1 . . - .1 t _ 1'3 /~-~-.c~/" /•~i ~ . - r. . . I HEREBY CERTIFY THE ABOVE TO BE A TRUE ~II~X~E'~`,4=t3P,~ ;OF'-'!'HE DEATH CERTIFICATE FILED IN THIS OFFICE. . : i~ ~ t ~ ! • = - ~ ` ' r ~ , MaY 2 ~ i975 ~~f ~ - : ~ ~ ' ~ - ; - u`?--:~ . ~ ' ly..' - r - _ . . "r , . (D~TE SA~~'DRA A. DELISLE, .DBPUTY 'REGISTP~AR s°ooK 24U ~acf ~8~7 ' _ - . s _ 4__..: _ ~ _ . ' . _ . . . . . _ _ ' ' ~