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HomeMy WebLinkAbout0556 --a------- - - - - - - - rni~ D~- dTAT[ NOARD ~F Hr~?t,TM ~ERTIF[CATE ~F DEATH ^ cu~os t DURUU OF VlT/li. 1TAT1~'TiC• tTAT[ t'ILr NO.- ~ x ~ i ~ l 1iaa1 FLORIDR °fd ~h°^ 91RTH NO. R[O Q'TRAR•S NO. ut~cuted 1. PIAtE O!r atATT1 GO NO. Z. ~WT ~ NIKMt[(wiwtia+~dli 8 ICOUNTYw~: Rrib++eWw•~iwf~w) rroPe'l~ i nnd •111 ~NTM e. p~~~.a ~3roward ~d~ F~rida Br~Kard ~ in p~~- A. CIri. TOWN, OR LOCATION t: IS ?LAtE Of OEATII t. CITY. Tp1YN, Oil LOtATqN e. IS 11ESIDEMCE aan~nt INiIDE ITY UMfT31 ?AS~AE_CITY llNl~ . r:i.. Fort Lauderdale YES~I ~op Fort Iaudardale Y~S ~„o t yyy~~~ f. NAME OF _ (//~ef M~upltd~ NM thK! d~tN) I. STRE(T ADORES3 HOSrITAI OR INSTITUTp?Ib.O.A. Hol. Croas Hos ital 1818 E. Oakland Park Beach Blvd. 3. MAM[ OF FYrN Mli~fi Lsif OATE MonfA Da~ Year c~~~a VERA WOODS MC KOAN F;,,r?~DeCember 1Z 1965 SEX ~ 0. COI~t o~ R~tx ~ i. MARItffOLl KfYEl1 MA411lEO (J r:• : :.'Fi: ---e ~ t•~ • yr.r ,.se N r i c. Fema;le White rmoowEO O avoac~n ~C • 5~~8~ t~~r1~'~~ x..w • W/r ~H~srs^ Xf~. P 1 a i° i~ ~0+. usu~~ oeeur~?Tah (aur trat efrort so~e idl. KIK60F ~USIt1E5S OR tNOl15tRY 11. NRTHPLAC[ (Aaft er J6?t1/~i t~tnh/) l. emun os ww~r oourtarr •1 tA p~~- lurlr~ wort o rrallaf liJt, a~e tJr~ftrNl ••^•~c Housew~.fe at home Mass~~titT~ett~ U. S. A. black lnk ~3. FATNER'S NRME 14. NOTHEII'S NAIOEM lUME or c,a..~~ c.r EdWin hbods Len3 15. 11fA4 GECEAS[D EYE11 IN U. 5. ANMEO FpRCE51 16. SOCIAI SECURITY NO, f iIAT Ri T p - ' lYa. w. ~alv.wf lll M. ~fM var w iW~ w~ a.s+or) • a~ t7 D.ge h L' . Tic Ko an no unk. Au.. . , a e a. . Fun~ral ~S. CAUK 0/ OtATM (61l~ ~nI/ o~t tttttt ptr If~t/br (D), aeJ (c).) [j ~ O O K ~tR[RYAL BET1AfEEN d 1 e to • r~RZ i. oe~?m w~s eAUSeo sr: - oTI I~~a~ ~~C~~ • OkSEi AXU DFATN ~ust file 1MMEDlATE CAUSE Rh• eer- ~ tifie~ta C~f~~.~ ~ n~, ~ •tEA CA• ~cRld Jvt i/~ [i oVE TO (b) b~ t~~}T ~+'~?1 ~ 1 o e• 1 ~broe csru l reai~traT 1~~R~~cor?r tat. ~E TO (e) ~ ~~J~ ¦f thin 7a z A04~ f- F ?ART II. OTMEA SitlQtKAM'CQY~fTA7ftf OGMiRM!l~1R id OGM iliT IqT itEUTED TO iM TEl[~ ~?lRCpAIiIQM Q ~1 ~ [a~. . YYAS AUTOPSY t~~ d~atl~ ~ , TERiORME01 s ~~~c;~ ca ~~t~i~~ ~r. ~s ~a or b~tore ~ pEXR ~}~p~ ~wURYOtCVRRED. (E1e/p apfY?s • t~ 1~ a! I! ~Jk~w ~~J satin~ •hy ACCIDENT SUICIDE HpMICIOE ~ r asspo.!- ~ ~ f cfon •f T1M ~}/err Mo~fA. Da~. Yra Dody. uuuRr ~ ~ / ~ . IKJURY OCCVI11tED . M.ACE OF If1,1U11Y i~ N~(qy1 ~se1e, IOJ. ITY. . Q~ LOtATION ODUNTY TATE wHILE AT ~ MpT 1NHILE ~a~ I~'/ rtd. o,/tet bf~y., ~lt.) ~ Yl01lK AT 1MORK ~t~ 21. I~lw~d t11~ dooo~i d h m . fo ~nd hat s s hl~ all?s or? Os,th yf»~ tt ~ u10+1 fh~ d*t~ ~ f~f~ ~Qore: !nd to th~ w~f ol m~ ~naw~/~d~~, l~on~ fh~ wu~~a ~t~ted. Al1 It~!• - - s~? to b• ~ ll~Nr aWl1) ~ ~ A~ - _ [2~~P+?ft s~8ME9 . eoiyl~t• ~ t (s ~~eCU~att. ~ a. A~ NAME CEMETERYpilC11EMATORY 23/. LOCATqN(Cif1. qew.wtsr~lly) (STdt) Remova'~~BprNh' 12-13-196s Suffotk County Mass. ~7- n•~. f 41 a j{. FUF1E~ 'i 4lGMii E RECD, fY LOCAi R[Q. T 'S SlGMATU ~l% ~irch3~'l~uneral Home ~ ~ / / ~ ~ A~r.1066 • ,RJ, I'`t+. Lauder~ale ~''~8 • (p ; ' ' ~q . . • ~ = • ~ " ~ - - CERTIFIED COPY ~ - . . , _ r ~ c . ' ' . . -:..:.'t~_ j,~~~~'hereby certify the above to be e true and oorreat aopy of the Local . Regidtrer~ s reoord o» file in the BroMa~d County H~glth Depertment st i < i •fiort Lauderdele9 Floridao ~ ~R•'~. 1 • ~ . (Wsrningt Not dalid~unle~e re~iaed eeal og the Brovard County Aealth _ D p~irt~nsnt is aff~aced. } ; ~ . ; ~ ; ~ ; . ~ . ; ~ ~ L~ ~ ' ' C • • • • . _ `v` . . •w!• V • . ~L~~ {n~ ~ T ~ , t • . ~ " ~C~ f . ~ t# i ` , +e W ~ ' 1 ~ ~ ~ ~ - : ~ : ~ : . Count~ gealth Offioer snd Looe~2 Registrar = ~ _ 4• 2 ? ' ' . ie . ~..1 ' . • . ' ` ' . ~4n.~ ~ ~ ' ~ ~ • , . j ~ ~ ~ U~~~~ • g R ~ '•s: . , D~puti Looa2 Registrar ' ~ ooK 1.~~ . . ~ , ~ . . . , . ' . , j !,k - ..t . . - - ' - ~ - . ~ . ~