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HomeMy WebLinkAbout0728 ~ - , _ _ . T~,.~ a~... ~e., ~..,,r„ CERTIFICATE OF DEATH t;~4 -f t~r~~:2 ~ ~L' °p~~~ • OUR[}~U OF VIfAL lTAYIY'1'iC• ~TAT[ FIL1C'R~''-~-~"~' l•s•l FLORIDA . - ord rhon BIRT NO. RE6 STRAR•s NO - p~ope~l~ 2. YiUAI R[SIC[KC[(1I?ar.s,res~tlis.f. tJt,ati+.~ew+: trid.srWrnsi~4~ww) •a~cut~d ~UC[ 01 D[JlTM COD[ NO. •nd ¦ill ~uNTM STATE 0. COUNTY D• plac~d t ~,Ll ~6 ~ ~ in p~!- 0. CiTY. TOWN.OR WG?TqN t. IS ?LACC Of DEATN t. CITY. TOYYN.OR LOCATqM e. IS RESIDfNCE , i s~D~AL IRSIDE C17Y LIMITST INSIDE GITY UMIYSI `i fil~. F`t Pj,CT' YES MO? YES[$ NO? i, ttAME OF (Jf pp~ fw ?erpilaJ, /'vt ~(rtd sl1nH) LENGTH OF I. STIIEET ADDRESS ON A FARMt ~ 1 STITU'f10N 1 STAY IN 1D YES ~ NO ? ' ~ J. MAM! 9~ FfrN N1Qdlt Lsit 1. DATE MoRU Day YtY on~+ JOSE?H HIRAM SHEASLEY °f"T" Jan. 1 1 6 S. SfX 6.~ CQLOR OR MCE MARAKD ~ NEVFR MARIt~[0 ~TE OF ~I11TN 9. acc (ls r~o, r~~ ~ Y~ UxDEr H?YK. lsr! bVtll~l) X~.L4 D+w X~n Xh. . ` r i s• Z/,~e Yr'hite wioowcu? aw+~cco 1-188 plalnl~ ~Q~,USWLOCCUtATqN(OfOtlf~Ief~OI/I~Ont IQ6.KINDOF/USINfSSORIN0U3T0.Y 11./IRT?IfIACE($ett~t/¢I~t~tt0itatti) 1 •t(T~IF7IO~MMATOOWiTRYi rith p~r- Irrf~~we~fo/xotlta/liJe.trt~iJ?/tirtA s~n~nt Rezlatol' Re3.l. ESt.at.C Oh~O U.S.A. Dl~ek 1nk FATHER'S NAME 1~. MOTNE~'S wAipFN Ic71ME OP ~~P•¦~~~•~ Jose h Sheasle Ea~ma Martin ~ 1S. WAS DECEASEO EY[I1 IN U. S. AIIMED i011CY51 16. SOCUI SECU111TY MO. 17• INfORMA ~ S90KATdRE ~~.s ~ ~ry L• S}1C 351CV ' ~ I YN. M. K tw~ Vrv l/I KI. /iN M/ M~O4t ~~IIi0t1 Yes 61W I 2b2- 0-979 ~+j~~~~ b o1 South U.s. 1 ~un~?~l ~1. CAY6t 0/ YiAYN ~b~k?oR!/ owt t~~ut ptrll~as~+? (6), tsl INTERVALlETWEEM ~ d! t t o r ?Al1T L DfATH WAS CAUSED ~Y: Or~HS~~ET ANO DEATH INNECIATE CAVSE Pneumonia 1W~ weeks ¦uft fll• tE• e~r- ' ~s o~r~~.:. cbx~u~,,r~.... ~,E To ce~ Metastatic carcinoma of the rostate . ~ .sce ea. ~cA1tA ~tet .u ~e • i , e . ~ .e~.< <.4r. 1•~. ~ with paraplegia : . ~ ` - ` E~.vc years Matr tAs r~tu. . r~6latr~r 1/f~~ t~r~t !a!. ~E TO (c) • ~ ?our.~• O MIIT 11. OitK115sGhHKAIR CdtqT10!d CqrtRtRlfeq f0 OFATM DlR 110T IlEU7ED TO TXC TLIMUMI 015EAS[ COMCITlCt1,C1Yi11 W1MT I(~) "j~RfQRMf~ ~ I t~~ d~4tb ~ _ • ' ~ Sfl :MO~ o• b~ fo?• 4~ ~ ZpD. DESCRI6E 1iOW WURY OCtURRED. (E'~ft? wW~rs eJh~Jr?/ f~ W+t l a Put 1 0/Kfsa lIJ , . ¦~tlns an~ ~ ACtfDFNT SU1CIDf tiOM11CIDE . ~z.po.~- ~ O D O _ .on ot p~. Ti~E os I/orr Mowt1. thr. Y~a - ood~. ~ ~ uuullY A. - ' ` . . C D. w. ' . . ~ 20d. ~NIUIIY OCCU~71[~ 20t. ?U1tE OF ~tUURY (r. is a sM~! Aoctt, 2AJ. CRY, TOWN. Oll IOCATqX GOiIMTT• STA7E wNitE ~T ~ i+OT wHKE ~ /uw.ladal. urut, eatu Diq., att.) • 1YOAK ATWOIIK - ~ ~ 2~• I~tf~nd~d fh~dk~a~~d/rom NOV. ~9b~ ,~o death •ndla~ts~n h,m ~lirron - - D~ath oesuu~d ~t a'~_P- m on th~ d~t~ ~t~t~d abor~; ~nd to th~ b~~t o! m~ kno~+Ndj~. Irom tA~ c~uNa ~t~t~d. ; A]1 lt~~• jj~. N4NATYR[ (DrprttWfillt) 2~8. ADORES ~ ~ ~0.2 h0 • Seventh S~. a+r¢ swre~o •r• to ls ; eOipl•~• ~ b:elvin k'olkowsic;~ M.D. Fort Pierce Fla. 2-5-65 ~ aaeY~~E~. ~~l.qtLr~TqM, 23d. DATE Zk. HAMEOiCEKET[RYORCREMATORY 23/. LOCATqFI(GY/,tpe~.Mto~ft(/7 (~~t) I R[rov~t SptciJ/1 , Buria~ 2- -6 Hillcrest Cemete Ft. Pierce Fla. ~ Y. 8. /63~ j~. FUNERAL W o,~ ~s sw~~n,~E yat~~,p~eral ~.~e 2S• pATE RECO. ~Y LOC/LL IIEG. . REGISTMR'S SKXATI7RE ; I R... ~oae 2_g..65 Anna Lee Denison, d. r. ~ r Jose h W. Yates Ft.Pierce,Fla. - - - . - - ~ , - - - ~ ; • ~ + i this to be a true ~nd wrract copy of the loca: ~ L E D~a N D R E C 0 R D E D ; ~ I cre~jr.' ~~1j( 4 ~ •~~Q e~istrp+'s r rd ot~ fib in the St. Lucie County Health Oepart- 8t--~~~t~, 0 0 K ~ . ~ ~ r~rtt~`at ~o/rt ~Pieibe." florida. ~ j _ . ~ J ~ / . :s .(Vyeming~ K!~ valid unless~ raised se~l ~f the St. lucie i~~ J~~r ~ 3 ~I f,~ ~Q : 2 2 ~ Coiih~ HeOhh Ue artment is 3ffix@d.) _ ~ ~ , 1c~ nr = - ~ ~ N. D. MILL~R, M. O. R 0 G 3 _ ~ JJ~ ~ ~ , - ~ ~ ~ ~ ~ . ;,`~County Nealth Officer ~ lotal Registror ~ ' ~ ' ' ; ; :1:=. ~ LC R ~ ; , ) , ~ ~T. LUCIE C~7UNTY. ~ - • ~ • FLORIDA i . ~ ~.j''~~~., ; ~ p~ Deputy Local Registrar d. r, . s a . . ~ aooK ~ _ ~ ~ R 1~36 ~~3 ~ ~ ; ~ ~