Loading...
HomeMy WebLinkAbout0936 ~s~s ..w...e..r~..: CERTIFICATE OF DEATM rroE lOC~1l f~lE NO 6~5 ~ F L O R i D A ST~TE i~lE MO J~ ~q~NT ^£CEUE'.' ':aME ~!~+SL MipDIE L~ST $Ex OATE O~ OEATHi41o 0~~ Yr ~ BLACtt " ~NK SEE r ? ~ ~+~ND60011 FQp RACE • q hr.fe B~a!• A(~E- lail B~~'^Ja~' U~1DEA ~ YEAN U*I~EA ! GA? ~JATE ~f B~~TH~MO Di? Y: ~ COUNLV Qi QEATH ~45~R~TiOH1 Am ~^n-a' Nc rSLVC~~~, ,r.s~ MOS ~ DAIS MOUftS ~ 4W5 . White ~ 86 56 x 6 A ril 14 I898 St. Lucie 6602 C"v TOWNORtOCA710NJ~ OEaTM NOSP~TAIOROTHEQ~NSi~TUT1pN-rWmell/npt.n~,tM~ q~r~si~s~~~~+On~rnpM~ if NOS~ OR~NST ~Ind,uteDOA OP E~*e~ s~~ ~~ca~~cn: ~SO~crr~ ~o Ft. Pierce Lawnwood MediCal enter » DOA STSTEO~B~RiN;ir~or.~ C~T~ZFNOivcre+~TCOUNTFr waa~EbNEVEAU~RqiED SURwviNGS~OUSE~~i.~N.p,.e~+aa~~nainsi US• ~aTecounn~~ w~DOwED DWORCE06Spec.ryl ^EA~N s Nebraska .a t15A +o Never rr d T`RFED ~N $p~~Ai SECURtTV NUMgEQ VSWL OCCUPAT~ON ~G.w ~~~0 0l ro~k Oone aunnq KiN~ Oi BUS~NESS OA INDUSTRV uriprr _-=E HnrvDBOOK m~osro~~a~,~9~.f~ ~r~n.~.u..Mi ~aRO~~ ~,z 2_ Z_ 2 I v i a or Br dstreet '~-~~~LETi~ntOF REStDENCE-STATE COUNTr C~TV TOK'rtOQIOCATiON STREETANDNUMBFR t7VS7QEC~iY~tl~llTS <~E S:JEHCE ~TEMS r5p~u~r Y~s o• No1 S ~k P tw_ r r. No FATMER-N4ME ~IRST MIDOIE LAST MOTHER-YA~pENNAME FIRST 41DDLE LAST - t5 r !6 Dimon > IN~OR4ANT -NAME i l~p~ d 0~~~~~ MAt~ING ADCAFSS STREET O~ R~ D NO C~TV OA TOWN STATE Z~P - - f +~o Pre A~ran~ements , - BUA~AL CAeMATION P,EMOVAL OTMEp~Spea!~i ~CENEtERYORGnEMA!ORV-NaME I~OCATIpN CITYORTQN`~N STATE _ ~ , • ~ t6a •do It6c FUHEAAL O~a TOp-~ g~~furl~ ~ ~ UNERAL NOM£ ADDRESS ~ ,9~ ? ' '19~ Ft _ 33450 , ; i 7Ca To tne oes~ o~ r*.~, .row~~e^ atn occu.reo at tne aate ana c'ace anG d.,e 2ia On tne Davs or e¦am~nar.on snO.~o. m.eyt,qai~~r+ my op~rny, pcatn occwreC n trx = au ro me ause;s~ s[a:e0 a~ bme. Oafe anA Wace an0 Oue ~o tne uusetsl state0 a i~ (S~0^~hre n0 Te4) ~ ~ # fSWnNUw rM ittM) ~ _ ~ ~~O OATES_ ~GN=O~~~= HO Q=D~AaO ~ DATE SiGNEO rMO. OaY r~+ MOUpOFDEATN ~ ! _ Uz ~ 0 ~ A1 u< z+o 2~c M _ > u E~ NA4E O~ ATTEriD~YG R~VS~G~aN !F OTHER TNAN CEiiT1RE~i ~7Ype or Pnnt; Ep GRONOUHCED DEAD ~No Car vr ~ GR'JYOUNCEDOEADrhfouii _ r- ~ ~W V Y_Q 2t0 ON 21e AT M = hAME AND ApCqESS OF CEA~iiiER ~~nvS~C~AN MEDiC~~ ExAM;NEA~ i i~pe o~C~-~t~ = ~z da 33450 • R£GISTRAR ' ~ p~.7E RECfivFDB?' AEGiSiqqa~a~o Dar. n~ -ouo,T~o*,s z~' •S°~^•'"'•~? l' C~ ~ic~,~ z3o ,7u1 19 1984 .4N~ ^H G~vE 2~ 'ML~ED~ATS'I~ ~USE {f~NTER Ov: r ONF C~u E eE uNE FOR ~s~ ~cr A~C ~c, ; ~ ~ir!er.~~ p¢t.ee~ w,xy ana xatn ~.~AMED ~E ~MT ~a ~ ~ .J~~"'•~ ~ V~K ~ ~~~r~ ~~/{'~rf.~f~It 1 /D ~~C.! CAUSE ~a~ ~ ~ ~ Vi ;*4TING TME DJE TO OH A$ A ~QNSEQuEvCE GF ~~~t!•rlt Cetw n onstt ar.C Ceiln ^hDERLYING ~~AUS£LAST ~ I DuE TO OR wS ~ Ct~tiSEUUEr:CE OF I rnoe~.a~ cec.ec~ o-set a~c oea~r. 1 • ~ ~AfiT ~ v~r.-.ciCxY* C~1.~'?Jh'S- ~s~c'c-.s _r•n.'-5'0 ~ a.; .~+a •a+s:eu'~ ca..se 9tir+ r P.UiT ,;t: IAltT 111 rt FEUw.E v.i5 irc?f • a~„•nv5v US~ a~cECa+ED 'O 4Etf'a~.. ¦ GFE'i`.~++Cr W i1~Pl5T 3 ~Or.'~lS'> ro/ crAAMnER ;SC+ec'r .es a v~ res r+o J~ n ~ .P.ocao~.~ ~CC~DE4r Su~C~DE a DATE OF INJUFiY t1A0-. Oiy. Yr.) HOVR QF INJURY OESGF~BE r{~M1r iNJVRr pCCVaaEC , H6MiGiDf arUNDETEF~A,NED~Sprairr -^S ~?:'+S}2 ~7a 2;D 2t¢ M ZJO ~~Re,p,~.~ ItiJURV AT N'pqK ~Splo'r PIACE OG iNJtJp~-At ~~xne is:m srrK~. factpry olhce iDCAT~QN <<REET OA p F O NO C~tY CR Tpn'f: STATE ~e~ 92 e~°on ~os w vo~ a:~~s:~.q eec iSOro~v; .S 6'21 2~! 1T ~ nEtrepy C~rhty this to oe a~~. r, r~v 16 ru0 •~6 ~ Registrar's re-o~:i on -L~, copy pf trtp ~o~i met?t at Forr P ~e ~ . ' ~~unry Health DsWrt• , ' - ~ FiL~: U (Warning: Nos v.; , . County _ . , ~h~ ct. luci~ ROGF? ; - ~ z iif~xed.) ST. LUC.' . ~ ~ s_. _ . r' ti~'. ~ vt p, ~~~5 'jJ ..~6 ? ~ u~ ne~~th Off~cer ~ . . • . ' - , ~Q~i ( _ ~ , • ~ ll~a.~+CJ • . ~ Y ~:r ~~W LoCet Reaic• r ~ ~ ~ . . ~ F i~~~~~( p~rf :~.h~ ~ ~,~~z~ . -