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Home My WebLink About1589 rei. e~- ~'TATt iOARD or Hswi.rn CERTlFICA1'~O~ LaEA7H eost• a SURRJIU Of VITAL eTATIl7'ICi fTAT! flLt NO. F~~R1DR • : erd tA~n S~ A : ~.a~srl~ i. tL1tC[ KATN COD[ HO. . YiYAI w[~i0i1lCQ(pAa~iwa/taoi /1iWiwe++a: RwN~+lr~iwviis:r::s) ? •a~cuttd ~ ~XTM STATE • D. COUXTY ~ •nd •111 - • „ + le ~fae~A ~ ~p p~p_ D. CITY.TOwM,O LOtATqfl t. IS fIACE Of DEATH t. CiTY.T0IYN.OR LOCATqM t. IS RE IDENCE g •~n~at INSIDE CITY IIMIT51 11f110E CI'Tl' LItllT3f ~ fil~. YES[~ !q r'LS NO l. NAME Of ~/J~t !w AWpi(d, ~t ~trte! aldttu) 1. STREET AD6RESS ~ HOSIITAI OR ` IMSTITUTqN c- r ~ : ~ 3. 11wli= O~ FI,N NIIIi~ Lstl DATE Mon!? De1 Yta _ eieusc• ~ ~ ~l~Iu N WfR11 OEATH tJ ~ ' ~ 6 S SEX 6 COIOR OR KACE 1 N~RII~ED ~J kEVEl1 MARRiED D~TE Of ~111TH 9 AGE (I~ ttn~ 11~R ~ 1~EM Iia0E+1 t~ MK- lu! bi?ti1q1 ~y~„cy pn. Xww xi~.. r t c. W1DOMtED avoRCCO 2 ` ~ r 1~ ial ~ SUAL OCtU?ATqM (Qitt ttnd sJror! Lont 10D- XINDO~ ~USI7ffS50R INDUSTNY 11. ~10.TMKACE (Stale or/ortl/w t~~~lr/1 1. C1?IIEH 0~ ~T COlAti17t ~ p • 1 t li p~ ~f/rr~n~ moet o/ ~oor?in~ 1~Je, rea~ iJ?rflrrll `c ¦an~nt & 8 C ~da _ D1aCk !nk ~j,'~7KER'S NANE 14. MOTNCR'S MAIDEN /UME ~ Ot t1P~srit~r ~ : ~ , • r. ~r. ~.5 IS. WAS DECEASED EVfR IM U 5. A11ME0 iORCCS~ 16 SOCIAL SECURITY 110. 17. INFY9lMAMT !•lelOATYR[ ~ i• i I Yu, w. R~+l+~~l 1!I w~. Nrr w~r Mtn ew+w~ ~.ildred J. ~~odkin { . wu,~u n • e,• ida ~ Eunstal IS CAYf[ O~ OtATX (!i'x!t?ew!/ oRt «rfs ptr li+u fer (D) ~ef (t).) IMTEIIVAL ~ETYfEEp ?ART L D[ATH WAS CAUSED !Y~ 0lKET AMD DEATH ' Al~~~tof ' ~MMEOtATE CAUSE (~t,~qhot wQ~~nd oP l~e~_ e ~3 •u~t tsle . ' tA• e~r- , : tifleat• Cosl'uto+u.~lae?. DuE TO l0) - ,1 -;1~~~ 3 ' •1tA the rAirA ~¢r~ ru~ to T- ~ t 1 o e• 1 oDxe teru s - ~~~[lit~~~ ~fotfr/ t~t unlrr- DIiE TO f.)---------- . ~ .=r--- ~ _ •itAin 79 l~i~/ car~r Inu ' . ~ ~ART 11. OTIEIt $lGM.fKAYi CfJMDtiq~iS CpfTRt~tlT11/6 TO OEATM !l!f NOT REIAiFD t0 iH£ iiRMtlbll DISUSf COk01f1UM CR1tN ~f7~L1(~) :.~~0~ E~Y 3 dour~ •t- ' ~ ` - - t~~ dsatA ~ _ . - i ~ ~ YESO~fvD? or E~tor• ~ ~ - ' pp lR 1 2~'i OESCRiiE HOW INIURY OCCUQRED tERrrr wdare oJ+a/rr~ Pvt:l of-Pvr 1~ bjltf~ Id.), _ a::in~ an~ ~ ACCtDENT SUICiDE MOk1t10E - • ~ ' ~ - i ~+i•?'°'- O ? Se1f inf~ icted :oe or ~ . . - 20r TIME OF floar Moe14, D~/, Y~sr .odl• ~NJURY a. , ~ • ~ . ~ - ~ . 1 f ' . = IOd. INIURY OCCURRED LOt. ~I.ACE Oi iNl1JRY (t. 1n or s.M1OW Aor+u, ~1J. CITY. TOWM. 071 ~OCA7~ON '~11 QAyN7Y STATE - wn~~ ~r 0 lIOT WH~LE /a-+~.lxrorr. x,ra~ oetee dry.. <<r.~ - .ao~K wo~K Fort Yieree St. I~cie Florida ~ i 2~- / ~tNnd~d th~ doea~s~d hom ~1+Ot Reen ~1`? Qia t.n dQ$tn_ and h~t qw A~~ •lir~ on ~ - D~~fh xeurr~d ~t m on tAs d~t~ ~t~t~d ~6ors: ~nd to fh~ b~~t o! m~ knosl~dh• from th~ eau~s~ itetsd. _ ~11 1 t~o~ j~ WBy~TURi ([h~re~ or t1~te) 22A ADDAESS . 22t. DATE S1GlOEO ~ •t• to D• y r co~pl~t• ~ ; ~ ;j U }t1h18CUS ~td. ~ ~b~ ~ tCCY?at~. ~p~Tioq j~p DATE 23c NAME OF CEMETENY OR C11EM~T0llY 2~/. ~OGT19N ((it~, f0~v~l.~tls~st)) ~~~+1~ ~ trovu 5 ri 1 ~ ~ a ~ , 'i` £ _1 _ FaU~ Reach 1•.em. Park Iantana ~lori.dd ~ ~ 9. je12 j4, FUKERA4. OR S SfGfItSl7AE ~ ~E~ S St 25 DATE RECD. ~ll LOCAI REG. 26. REGKTRAR'3 51GNATYRE • 7N~ ~ R...'°ee _-M~~~an=_i~. Tiaird - t~`t.?ierc~ Fla. 7-2?_-65 Annt~ Lee Denison d.r. _ ' FtLED AND. RECORDED = ~ ',:'''~-:~'C l,ocal ~N~~~i~--~Ctl~._300K ~ .:'~.~1 •~}~~by ~ certify -fhis to be a true and correct copy of the ~ R$giStipr s.Yecqrd o?? file ih the St. L~cie Cou~ty Heslth Depart- G~~.~C.~ ~ .1't~B'~it at Forf R.'e•~a _ ~~o•~d~. 66 FEB Z ~ ~Q : Q$ ` - ~ ' (VNa:ning: F:ct :~i ur.te:s~ r~:sed se.~l c,f 1h~ St. Lucie . ~~y . ~ • ~ ' - • Count ~,;'e, re;~arim°nt is 3fF: :e~J -t~l~.l_~ ~ ROGER P01'i RAS, CLERK • ~ ~ • ~ - ~ ~ ~ ST. LUGiE COUNTY. ~ ~ - ; ~ - \ N. D. J~A~II"~~, f.1. _ . . FLORIDA ; ' • - , County Neiif~ Cs~cr._er !4 l~~~l Registrar , ~ ~ • ' ~f;'~ 1 ^ S ~ ~ i . . r ~ ~ jl...~--~~'w' ' ~ i . ~ . - ~ pepuly Loca~ Registrarr ~'r'. } , , ~ ~ • ; MICROFI11li 1~0 ; ; ; Legibility of ~riting, typing ~ . ~ ~ ~ . ~ - or rinti ~ ~ k ~~°!~l ~~J ~ " ' # ~ , P n8 unsatisfactory in g0i)~ J, , ; thi e docuaMant f or mi crof i lming ~ "4 , - - E-.. . _ . _ ~ . . ' , ' ' ' . . .