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CERTIFICATE OP DE~1TH
OF
OLLIE GIGAX
Ii1 nE: Tl~ie Eas'i. %2 01' Trac:~ 28 of GARDIII C:ITY r'ARt1S,
according to plat thereof recorded in Plat
Book 2, at Page 5 ot the public records of
~ . St. Lucie County, Florida.
trt~ De- f7AT! BOARD o~ H~~.v~+ CE[~TIFICI~TE OF DEATH
co~es • BUR[AU OF VITAL <TATIGTIC• BTAtd FIL! NO.
i~a•l ~a~- . FLORIDA .
ord •Aen BIR7H NO. REGI6TRAR•8 PtO.
pTOpe~lp CODE NO. 2. UfUAI R[fIDENt[(Illa~f/ow~~fKw/. !/iwtitw~w: Rwil~+aWsr~s~wu~'w+)
~ eiatut~d 0f OGTH a. STATE D. COUMTY
and ¦111 ro~NTY ~
be plae~d
1a p~~_ A, UTY. TOWN,OA LOCATqN t. ~S PIACE Oi OEAIN t. CITY. TOWN,OR LOCATpM t. IS NESipENtE
•an~nt INSIOE CITY LIMITSt INSiDE C~TY UMITSI
Ft. Pierce YEs7U ~+o? F YESK] ~op
rii..
I. MAME OF (1/wot fw ?Oipild, /vt ilittl ai/rtN) t. LEMGTN OF I. STNEET ADORESS ON A FARMT
HOSPITAL OR STA~~`14D 12 0 Ave B YES? NOQ
IN3TITUTION Ft. Pierce Mem. Hos .
J. NAMt OF Fbif N(ddlr Zu! OATE MonU Dal Ytai
D[CGi[D ~
(?ypt or yrfat) D,~.~iA ~ H~I~.I63T1 ~ Gi 3X ~T„ A ril 2 1
S. SFX 6. OOLOR OR IIACE MARA~ED ? NEYER MARRIFD? 8. DATE Oi BIATH 9. AGE '1~ l~a• ~~`~a ~ T[A7t '~f.pEp t~ Hti
!uf D'utASe1) M+.w D.r~ R«w Xta,
~ i e. F. W. wioowEO avoxceo J11T18 20 1~ U 6
p 1~ 1 n 1 r ~pa, USUIIL OCCUPATqN (Oi~e li~d oJrak lort IOD. KI!IDOf !VSlNESSOR INOUSTItY I1. lIATMPLACE (Strft o? /ortlpr Micslr/) I2- CR1IU1 OF If1NT CQVhTRTi
~ith p~r- lariaawaleJfvo?tIRII~/t,ut~l/?ftLe1)
san~nt House~ife Osm Home Monet Missouri U.S.A.
DlaOk lnk ~3. FATHEA'S NAME 1!. MOTHER'S ?tA1GEM tKAME
t~v•*~~:~~ First name unavailable Hillman a Ell ha n -
1S. MfAS OfCEASED EYER IN U. S. AAMED ~ORCESI 16. SOCIAL SfCURITY NO. 17. IM/ORM f SIOMATYR[ V.~B ~ Geneva Platt ~
- I Yr. M. ~r sskMSh cfl hs~ w~r iWa wrr:nl 1'li
Atlrtu
~ Funo~~l 10. CAYK 0? ptATH (6+~ltr ptJ/ Ottt ts~u pq Jiru/~' (D). ~Af IKTERVAL EETWEEN '
OMS AND DEAriI
a,r.~co~ r~RT~.o~~Tx~:,~e~u~~~r: Cerebral hemorrha e l~ hrs.
¦~at fil• ~NMED4ATE CAUSE +
tb• e~r~
- tifieaN ~yR/uto+u,!/ta~. p~ TO (b) Arteriosclerosi~
- rith tr• rAk~ ~uY ri~ fo
1 o e • 1 ~'+ost «wu f~). •
sl~ttn/ tAs ral~r•
r~Rl~trar l~fy tanlt Iwl. ~1E TO (r)
• i tA 1 n 7Z 0 ~ANT 11. OYH£R 5lG~u?KVR OOttOtTlOtK COM7CMlTU~G T~ D~~ ~tR ~T REUTEO TO Ti+E T[Itruul OcSUS[ CO[t0~T~0+~ GNEM tM tNtT I(~) . WAS AUT(~PSY
PERfORM1:DT
Aour• •f-
~.r a.dob ~ Diabetes + h ertension ,~SO ?,o~
or e•for• ~~Pr ~ ~ry, pES~RIBE HOW IMJURY OCCURRED. (E4fp walrrt ~JiaJs~/ Is Put IOS Put 11 oJI(ta //J
a~kins •p7 ~ ACC~DENT SU~C~DE MOMKIOE .
+~spo~t- u ? ? ?
~ ion of
20e. TutE oF Hour MonU. Da~. S'rs?
oOd7• ~ IruUNY •.a.
~ o y-
7c 2(M. tTUURY OCCUR!!ED 2l1[. ~IACE OF IWURY (r. Ft~ Or ~vl 1GA.t. 2Q/. C1TY. TOWM, Oll LOUTlOfI OOUNTY STATE
WNILE AT ~ NOT WHILE ~ ~~~•/~al. k~trf. eQSct ~Ilp.. ttt.)
M'011K AT WORK
1~tf~nC~d fh~ d~os~~~d/rom 1 4 . to r• ~ •nd L~t ~aw h~m ~lirs on pr• ~1 ~
D~~fh occur~ed ~t ~2:~U A. m on th~ d~t~ st~tod ~6or~; ~nd to eh~ b~it oI m~ lnoat~d~~, /rom th~ uu~~i ~t~ted.
?ll lt~~• y~p~TYRt (D[O~tto~firle) 22A. ADD0.E55 21s. OATESIGMED
•r• to D• 4~29~5a
coapl~ta k Richard F. Sinnott, t;.D. ?Oti S. 6th. Ft. Pierce, Fla.
~ •etui ~t~. ~~u ~~itqit. Z3D. DATE 23c. NAME OF CEMETERY OR CREM~TORY 23d. LOCATION (Gl'lr. [o+cw• M tauat~) (SYolt)
~ w cs ~n~ Lucie Fla.
~ ~uriaY 5-2-58 Hillcrest Cemete F~. Pierce St.
V. 9. ~611 z{. FU1iERAl D~RE 011 ~5 SIGMATUAE AODRE5561O ~CB • C 25. DATE REC~. BY LOCAL R£G. REGISTNA0.'S 51GMATU1tE .
~ R...19aa * g• F Pierce Fla. -1-58 Anna Lee Denisen d. r.
- .:f, :
<<'' I~heia6y~'c~r~+fy,this to be a true and correct copy of the loca:
<;~'~Regisftar's rator8 op fik in the St. lutie Counry Heilth Oepart- F'~~~ NND RECOROEL3
` - ~ ^ mgM. ~t Fort ~Pi~rca, Florida. ~ 0 ~
(Warning: Nof valid unless raised se~l ~f the St. Lucia ' ~j~C~`~~
~ . County :Neaith Dopartment is affixed.) . ~~~C1a
. ~ ~ l
_ _ ~ . ~ . „ ~ ~ ~ 4
. . ;r~~ ~ Z~ P~1 •t
_ . . - N. D. MILL~R, M. . ~ _ „ i ~/~1f ~ ~ t.
' - r ~ ~ - ~ ~ • ~ ' Counry Health Officer & local Registrar ~
f • . . . . . . ~ - ; ! ~ F~t K
# .
1 ~ l ~ f~ - tn _ ~~~.a~ ~ _ J~ ~L_~ G i ~C ~ Y,
; p,~~ Deputy local Registror F LO i I D~-•
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