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HomeMy WebLinkAbout0735 t_~'~TIF1rOTE ~F DEATH -L`-}1o1~~~+ iois c.- :~;.Ta o~.:.~.:. :.F ~.o °0~~~ • BURiAU OF Y1TJ1L tTAT1iTlCf RTAYe FII.! NO.- ~ ''a'1 r"' FLOHIDA ord ¦hen B! 7 NO, pCd AR•e O. peop~~lr ai~CUt~d 1• iLAt[ 0? DiJ?TM CODE NO. 2. YfUAL IttNp[fICQ(wa.rtw.r.fk.d. J/p.,nn,t;.w; s~;~,w1~/.r,.1~;.,4.) aad •ill ~~n s. STATE 0. COU1tTY D• pl~e~d ln p*t- A. CITY. TOWN.OR IOCATIOM t. IS YLACE Of DfATH t, pTY, TOIYN.OR LOCATIOM s. IS RE5IDEKCE ~ asn~at INSiOE C(TY LIMITSI IMSIpE CITY llKlT51 Pil~. YES? 100 yEg }q_~_ . l. MAMf OF (1/M! hl ~Wpll~T, /iM 14~t! s~btl!) I. STRFET ADDAE55 ' IiOSPITA~ OR IHSTITUTIOM 3. ~MC or Ffr.c 1N1[~ur Lu~ OATE Mo*eA Dnr Yea cccus;a cT''~` f`''~) ANTO;V U T" D 5. SEX 6. ODLOR Oa RAtC 7• MARRiFD ? NEYfR MARRIEO ~TE OF lIRTH 9. AGE (l~ /tpa 1~? u+OER t YGUe tA~OER t~ w~.S. ~ fad bW.IJ~II x..w wri B~rr X:.. ` i c• M W wioowco ~l qVORCED ~a ~ r.alel~ 10..usu~~oCCUr~Tan(Ot+ettste~ra4lmu IOD.KfIf00F~U51!lES507tIMW5TRY 11.{lRTHDLRCF(bT~ftRJ~ltl/Nt1Y~d!) I.pilIIMCtflYITOpAfiRfi ~ •icn p~r- IsrJywoKo/~eptfs/liJr,~y.r~r,ti~ ¦~n~nt PAI~ITER OMI~1E A ~ Dlaoic 1Ak ~j, FATHEII'S MAME 1~. kOTHEN'S MAIOEN MAME or _ e~e„~o.~ MATTHEt: LEArdE1i , IS. 1rA3 OECEASED EYEh 1!1 U. S. ARMEO FU11CE51 16. SOCUL SECURITY N0. 17. N1I0 f iIiMATLRi . rr.........,~....~ u~....:....«.w.,~..,:~? ~'~a.theh Leanen NO 122-1 -0 Au'u+ - - Fun~ral tl. CAVSi oLATM [fibloswll~+n~1+Dt~lterJa (s). (D). Mt (r).] 1ARERYAI LETwEEM d 1 i e e t o ~ rAR71. CEATM MIAS CAUSED !Y~ ~u~t [11• IMMfOidTE tA{fSE ~ t6• ear isease titieat• ~~u{~~~/n!. p~ =p (0) ' ¦iee ta• m?ka e.r. r{~~ i o e a 1 ~Dwt tt~x , K~tix/ G1t awltr• . i . ; ; r~;iser~r i~~,y nwe lwt. ouE ro (c) ~ltala 7~ Z ~o~r s a f- ~ ~MT i~. ot~ !+a~r~uxr po!~atp~s Caxnawnu~a ro ourn Rrt Mtrr uum~ ro n~c tuwuw. Ocsust taanoN Wrvi N t~uT 1(~~ ~ : M~s ~ j : !FJtsoRt~d?. _ tsr d~~tL ~ or L~tor• ~ : ¦.tip = to.. t ta4. usca~~ r+ow inruwroccua+~ca (~rs. Rerws yl~.~ k. p+se J.. Pe?t 1 e/ r.t ~t i - . _ 6 ~ ACCIDfMT SUICIDE lqkIC10E L - . ,~'~po~!- a~ ? ~ ? - ' - - ~ • e! J TlHE OF Her/ Xn~ll, • - - . ^ ' 3 Dtf, Y~o - ~ - ' svdj. IlIJUNY M. _ : ~ /r•-. ~ ~ " i a D• w. _ - : . . W . ~r ~ . ~ ~ = 20/. tlUUII~ OCCU RREO ~t. KACE OF I?UUIIY (t. Ht a~tqrl ?eau. 2% CITY. TOY/N. OR tOCATqN . 1: t.~ 3TA ~ - WMFIEAT ~ NQT11M11E ~ lw~./6afN/.efltd,~JtttbllP•~dtJ ~./:`~f?i'~.~~~ts.••;'~,t~.. . YlOAK AT 1MOilK .~;i , ( ' 2~• !~tl~nd~d tM dw~aa~d Itom hT0`= - ~ q~~ C~EPB.t,Il •nd 1~~t ww ~li~~ on ~f' ~ ~-•~t}=.~1~ Dtith oeouttrd~t m on fh~ d~h it~t~d abo?r, and fo fh~ 6Mt olm~ Xno~vlyd(~, liom !A~ cauMa ~t~tsd. ' ~I1 li~a~ wa~TNR[ ; .r. so (n•r~raruu~ 22D. AbDRESS 802 No. Seventh St. o"TES~cnco ~ eo,p~.e. e Melvin Wolkows M.D. FT.PIERCE FLA. 1- -6 ~ •ooqf at~. ~~u ~~t~ ~ p,~TE L3t. NAME OF CEMET[RY OR CNEMATORY Y3/. LQCA770M (GY/, (Me~a, a!'9Y~ly) . rtcrovu Nitil ~ REl~A~~~L 1-2-b PALM BEACH PARK CREM. PALM BEACH COUi~TTY IDA V. a.+eia j{, fURFRAI 01 01l'S SICMATURE o/11 E9~rth. ST. 25• DATE 0.EC0, BY LAG1L REG. 2b. REGI5TRA1l'S StGKA?tlRE 7 ~r s••.'°e6 Milton W. Baird FT.PIERCE FLA. 1-6-65 Anna Lee Denison d r , { F :[3 rn ~ . ~ ~ - ~ ;2`j11~ir~iir~i~~~~~ . , ~ r ` ~~~~~1~i~t~tss~__r ~rd 4 fib inathe Sti luuo Cou ~pHe Ith~Oepa~t• ~ ~ ~ ' ~ : ~ ~ ~ s t , " fR : Pte~y Fiflrida. ' ; ~ ) : ti i',~ ~ - -r~ C ; ..r ~ ~Z ~ _(Wamli~g; qtyaltd uniess raised se~l cf the St. lucie r- c~ w ~C7 • ~ r ;s ' Co~~ty. ~{talth Department is 3ffix@d.) , _ O m _ , ' _ . ~ m ~ " ^ st r ~ti • . :t- „ ~ ~ ~ ~ __'~'',,i l~r~'•'.- =-~;i~;='~ N. D. MILL~R, M. D. D C~`• ~ p ~_~Q f? ~ i~'•~~~~.~ Coun t y Health Officer d~ laai Registror ~ - . - - , . , ~ ~ ry. : : : ' ~ r:,~ ' ~ Crfi ~ O @El r ~ ~ ~ ~ 1~ _l _ F ~ ~5~~'lJ... . ~ ~o 0 0 ~ jJ j~___~;,t~~ _ ~ ~ . + - ~ ~ .'i ~ ~Dat~, ~ ~ ? , DePutY lotal 'Registrar ~ . ~ i i; • . ' r ~ 's ~ . BOQK 136 ~~U Y #