HomeMy WebLinkAbout1131 tn~~ De- BTATi 90ARD oF Hew~rH CERTIF[CATE O~ DEATH ~.~%~~wti~~~
eoaes a g~RCAU OF Y!T!4!- 3'rAT!3'1°!GS S7A-.~ FIL~ li0.
leasl ~e~- FLORIDA
ord ¦Aen BIR7H NO. REGI6TRAR•S NO. 12~
properlr
eaeCUted rUCE Of DEATH COOE NO. 2. UiVA~ R[t10[MC[(W?n~t.c.r~Mt:~d !/i+~t~tat.e~~ Rrid~pLs;r~rl~v~uw)
•nd *111 a. COUNTY a. STATE D. COUNTYSt Lucie
ee pi.~~a St. Lucie bb-?CXX Flori~la •
ln p~~- a. CITY,TOWN.ORIOtAT10N ~5 PLACE OF OEATH C~TY.TOWN.OR LOtATqN e. 15 RESiDEHCE.
a~n~nt ~i't, Pierce INSIDE Cf-I-T~Y UMITST INSIDE CITY UMITSI
C11~- YESL~ i+o~ Ft. Yi2TC6 YES? noL~S
d. NA.aIE OF (lJnpl in ?apf[al, pitt ilttrl tld~ua) LENi.TH OF 0. STREET AC+DRESS
OM A fARMi
NST~TUTqN 0 S. Ind. Rvr.Dr. TAY~1: 91~~3
9~ 3 6 S. Ind. Rvr. Dr. YES? ?;o~
NAM[ O? <<Y~~! A!lddlt Lu[ OATE MowlA Da~ Ytar
c°7yv~of prfn!) FRANCFS GRE;I~OOD ST. JOIiN ~TH p t•, 11 1961
S. SEX 6. COLOR OR lIACE 7- MAFAIFD NEVfR MARRIED? 8~ DATE OF BIATH 9. A6E (!n ytar! u U~DER 1 YUA vypER l~ wt5.
fLt DVfAQG~) X~sW Da~ New+s Xi.~.
" ~ 1 c. F ~ w~oowEO p avoeceo Nov. 22 ~ 1889 1
I11 ~ ~Qp. USUAL OCCUPATION (Cift Ylnd O/~C07! dOAt IOD. !(INDOF OUSIHESSOR INOUSTRY 11. BIRTNPIA~E (Sfelt o~/o~tl~R tOLSf~~) 12- GTIZEX O~ K1WT COU!(i1tY1
• i th p~ r- Qnrinp mwl oJ tcorkin/ hJt, ~res !J?rtire()
••^•^c House~n-ife Urm Home Brooklyn, N.Y. U.S.A.
blaCt Snk ~3. FATHER'S MAME 14. MOTHER'S MAIDEN NAME
tTp~zriter Christian Hillabrand Elizabeth Wells
IS. WAS DECEASEO EYER IN U. 5. ARMED FORCE51 16. SOCiAL SECURITY k0. 17. IM?ORMAM i LIGMATYRt ~ S~~
~r...No YtiFM~eI w?~...~....•..•~•••~•~,;d~ rione Ad[rri9(~p3 S. Ind.
v~'
r~.
Xr.~F~P'ie~rce, FTa.-_
FuntT~l ~0. CAYK :!~LATFi [Islflt/ On1104t N4N ptr IirK fnr (0). ~xf (r).) IKTERVAL BETWEEN
tAMT L OEATH WAS CAUSE~ !Y3 l~,~ ET AHD OEJITH
d1T~tto~ ~MMEWATE CAUSE ~ s Carcinomz ~ years
•ues fil•
`n• Carcinoma of left breast ~ 10 ye~rs
t 1 f i e. t• Cond'Uiont, t/ a~ p~E TO (A) ~ -
~itD th• rAtc~ ou~ ru~ fo ~ ' • .
1 o c w 1 nGur tauu (o). • _
r• 1~t~~r a/alin/ tlt rs6rr- ~ -
6 1/in/ ca~~r lat. ~+E TO (c) ~
~ 1 th 1 n 77 O pART ~I. Oi1fA SKMiF]CAJ(i WtiO(Tql6 OOMiG~tffWG TO OEAM BVT !pT REU7ED TO TNE TFAMIKAI d5EA5F CU1iGilOM G~YEM 171 ~AIIT I(a) - WAS AUTDPSY ~
~ HOU~• •C- F . , - PERFORMCtD~tr
' t~r d~?t6 3 . . ~ . • ~ YES? HoL'i . .
~ or b~for• y
p~, lR aE 20D. DESCAIBf IiOW INJURY OCCURRED- (Enftr qafart of iwJst~ i~ Parl IOr Pv! IJ OJf(tq •
a~kiaa anJ ~ p~ ACC~DfNT SUItIDE HOMICIOE ~ . ~ .
df~po~1- W ? ? ? '
on ot ~ •
J 20c_ TIwE Of Neu~ XoalA, Del. Yev
~d]. u ItUURY •.t~. . . - ~ _ .
p y. w. '
~ 20d. ItUURY OCCURREO ~r. ?LACE OF lN.IURY (t. fr a o'wnl Aoa~, 20f. CITY. TOWX. 0~1 LOUTpN OdOMTY ' STATE
Wti~LE AT ~ !qT WHiI.E ~ /~4.J~or/, rl~~st, o~[n Gtlq., rlt.j -
WORK AT YYORK ,
Z~- I~tl~nd~d th~ dece~~sd lrom 12~9" 7 rn °1 ~ and ~ut ua~ ali?~ on 3- ~
~
D~~th occ~rndat • 3~ m on fhs d~t~ at~t~dabor~; and fo the bsst of m~lno~rl~d/~, lrom theuuaea atated.
I11 it~as ~,fIQMATURE ~
- •t• to D• (~~*«aruk) ?1b- ADDRESS 71t, DATESIGNEO
~o.p~.c. • Russell L. Counts, M.D. ~ ort Pierce, Fla. 4-11-61
~ •eeuiat~. ~ BUR1Al,CREf1ATpN, pATE 23c. NAMEO£CENETERYORCREMATORY 23d. LOCATqN(Gll~,fo~cq.ortouaf/)
Rtwovu (s ci/~l
Remova~ -1 -61 Delra~y Crematorium Delray Beach (Palm Beach Fla.
Y. ~b19 j~, fUKERAL DIRE OR'S SfGNATURE S5 7th S 25- DATE RECD. BY IOCAL itEG. 26• REGISTRAA'S SIGNATURE
R••.~osa ~ilton i"l. Barid ~~~ierce, ~Ia. 4-13-61 pnna I.ee Denison~ d.r.
~ ~ G E rJ D tL. or.~
i ' „ .r ~ . ~ ~ 3 2 31
-:I~ hereby ceMify t}iis to'be a true and correct copy of the loca:
. egistr rs eecord oh ,fi{e in the St. Lucie County He~lth Oepart- F I L E A ~`1 nR, ~E,~ ,C~,0,,~ R D E D
' . ment"a~ Fort Pierce;. Florida. '~r - O~f~cia~-R~114-'' ~ 0 K
; (Wamin4: Not v~lid unless raised seil cf the St. Lucie
~ . County_ F{ealth Da~artment ~s 3ffixed•) , . ~ ~,,~.,~a /
~ ~ '06 J,'~t~ 2 I PM . 3: 0 y
i . N. D. MILL~R, M. D.
, - Covnry Health Officer ~ tocal~ Regisfrar ~~~'~~x~t~~"'~
' , ROGCR :'vi i it~.~. CLtRK
1 ~
~ ' LUCIc COUNTY.
l- 1 -6~_ lr-~.~„_ 1_ _t? i FLORIDA .
. _
pa~ Deputy local Registror d. r• '
~ 3ooKi~Sb ~ 5~5 =