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Thls e.- .T,?T~ ~OARD o~ N~?~„~ CERTIFICATE OF DEATH ~ '
• ~unuu oF viTw~ .T~~snc. F L O S I D A ~wt~ ?~~t No.
l~a•1 r.e-
eN sh~e BI T NO. R[ STRA NO.
p r e p~ e 1 y 1_ ItAt[ Oi ~tATN GOD t NO. 2. YfYAt A[NKNCt (1?M.Irw.~ W II i..wwr.w: i•.6w w/... ~iiriw)
e=~tYt~d ~ ODYNTI/ STATE A. COUNTY '
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s• ~1~C~d ~ C1Q
1~ *~1- 0. CITr. TOMIN.OR LOCATION e. 15 ILACE Oi OEATM CITV. TOMN.OR LOtATqN r. IS 11 DENCE
•~N~t IN510E GlTY LIYITSt INStOE CITY IiMIT31
t! 1.. res ia ? res Mo
w?M OF (IjwM iR ~w~Nd. Ifn ~draf ~f6ar) f. STREET Aoo~E55
NI371TUT1011
Ft. Pierce liemorial- Hoe it B ad -
3- NiuK o1 Fh~ Lat 1. dITE XNt4 Dp Ym
~ MiARRF.N WILLIAM SWA7CrR ~*N November ?1~ 1965
. SEx t. oOtoR OR 1tAtE 7. MiuM~EO ~N[vElt wRR~[O DATE OF WTM 9- AGE Ih ~an ~ u~ou ~ rw uNOER M N~s.
t«t 6trNfnf x..r. p.. M... ~?t.. 1
r i e. Kale White .noowco O orMO~cw Se t. 14 1902 63
~ 1.~.1 ~ :Or. uswu. occur~~ otrr ttnt y~r! ~N.s toe_ [rw a N~su~E~oR wanr~r i wtTMKI?CE (3ti1s w hnl~w as*nr) 1 cmaM ar.wr aowmn
•it~ p~e- y~nr hJfr as~ ~Jreehd)
..p..e S~`i~~onary gineer Board o~ Educati n Ohio USA
ll~ak !e! 13 iATME11'S wtE . 1 MOTIIER'S MAiOt)I II~ME
er ~
tn~•~~~•~ James Swa er Hattie ~tin
t rns oec~co cvc~ a~ v. s ~arco ro~cES~ u. socu?~ scaR~Tr Mo. n. s sawsuwc Beasie H311 S~r er
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no 26~-60-9479 ~ 74b Brack - . erce, ori a
rdn...~ i~. ewYf[ w Kwrn tE~te..rr e.s c.... yn Hwe c.). (S)...t c~).~ ~Kruv1LL ~E~M~EN
e~~.~e.~ r~sT ~ oc~n, ru uusEO.r: Cerebrat e.mboliam ~c~a s~
tr~t !~1• IMMEOYITE UUSE
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e~rsa.~. ~ ~ ~b~ ~eumatic Haart diaeaae Yeara
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• 1 t bi e Ti ~ 11. Orrill S~CtilUUrt tpprio~s CqrtwIRMG i0 DEAn~ Mrt NOr 11E1ARD TO lrt 1tM10Nl DlRI?sE COIloliqll G1IiN M~MT 1(~) . 11AS AUTO/SY
YOYr• •i- ~ rER/ORMEOI
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¦~ki~t aw~ ~ 70.. Doe. ocsc~nc ~ww ruuer occun~co. t~.ra w.rws ytyrr* h wK 1 r P+rr tJ yMs. ~t.)
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•t mt. TIME OF H.r. u~u, n... r..
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~1/. MUYRY OCtURJtED mr. ?LACE Oi NUUIIY (r- I-. !i r~1 M~s. m/• CRl?. TOwN. O~ LOCATIOM COUNTY STATE
rl~eN.E AT ~ NOT NM~IE ~ /p~.1~~~?I. rhed. ~~oe WN•. efe.)
NORK AT MORK
t~• l~fNnd~dfMd~cwasdlrom ~ 7W , to dgte ~ndluta~w hem ~/ir~on
Dwth oeeurr~d ~t • a~ on th~ d~N ~t~t~d ~bo?~: ~nd to th~ bNt o! s~~ tnowNdN. from th~ uurp st~tM.
ll~ lt~~s s1GIMTY~[
sr• N i~ (~/?a or rWe) t2D AOORESS 22t. oAtE SK.NEO
a Alfred J. Cornille M.D. 0 Hibiacus Rd. i1-26-6
aee¦~~e~. Y3a. w,~u~. aErunow. z3e a?TC t7c. ruw[ ao ecwcTCer ae e~w~~r 23/_ tou~ (GS?t. ~ww, ev.,~t~) (~rs)
~iria~' 11 z7 65 Ft. Pierce Cemete Ft.Pierca Florida
v. s: f eis t~. svMC~u s s+wu?au,e~ g er me 2s. o+rc ~ccc. w wc.~ sEa. ~t. aoisr~~s sw~u?nne~
1... iods Joseph W. ~ YaLes, Ft. Piarce, Flori a 11-29-65 Anna Lae Denison, d. r.
~~2650 .
~~~by pKfity fh~s to be a true and co~rect copy ot ths wu' P2.•'Q
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Rp{str~s r~cord on file ~he S~. luue County Heaith D~pa~t• ~
nfNM at Fo~ Pierce, Fforida. .
(Waming: Not vahd untess raiseci seal of fhe Sf. ~ud~ ~ FILED r~"t'r• ``~':Jr'-
Gounty Health DeF~artr~ent is affixed.) STGLU~I~~~~~pj i FR~
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