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HomeMy WebLinkAbout0937 ~ . ~ / ' CERTIFICATE OF DEAT~. • Fj~481s F.,0 9 2 9 F L O R 1 D A STATE ~tlE NO vroE i?W ~~NT pFtEDENf N~ME ~~HS~ Mi~J~E l~Sr jEx OAiE O~ DE~Trr~M~D~r v~ ~ Fi ~CK iHK i~~j~ i;uechenberc ? 1 ~ SEE t ~ x N:~dOpK {pq RF.f.E r.j Y.^~te &aCl AiiE ~l.titE3 ~tr..13y ~ ~.h:1EA t rE/~R l;l~JER t DAY DATE O~ H1RTM:MJ Uer Y~ ; COIiNiY O~ DEATH ~~,y.q~T~~ Am ~~:r.an Fic ,St~en~s~ ~Y'S ~ MOS ~ O~rS ~~OURS ~ MiNS bb02 a W~~ ~ 6 s6 S` 6 ~ ta ~ C~TY TOWNORIOCATIOND~OEATN '+USC~TA~Op07HERINSIITUTION-Name!~~~ro~~~~r~~re~ q~.e3r~K~~n~,•„~rte~i ~Fr~OSP ORiNSi ~.~r.~.ca!eCOA OPE~ier R~~ in~abent.Spc~eYi „~brt Pierce Lawnwood M~edical Center T, DQ~ ~ . - $T4TEOFB~ATHi~1na•~~ GIfILENOFItiNAiCO'JNTHY MARRiEO NEY[RMARRiEO SUR':~Y:NGS~OUSE,H.,le g~.e~r~3~~fen,~~c~e~ USR ~~3mec0~~^~•y~ +V1.^,OnEO OiYURCfD1SM.:+h~ ~ . E a~r. E ~ .q ~0 n ''~~~N SOC~~! SECC~i7vNUMBEfi US~..AL(~;CUFATiON~G~ve~~-~ad~o•~vo~a::~-^; K!NDOLBUS~NE550R!NDUSTRr -~•t,:T,uN 261~28-8597 /~S;O~~Or1?rcJi~!f e.e•~~~~er.rtoi - ~~"'0DpO1 Nurses Aide Nursin . . ',~5i;~hG ~ 12 iJa : f~ONOi 'E lifMS REy:6ENCE STATE COUNTV UYY TC+tiNOi1LOCAT~CN S7REET ANC `~l;MBER ~NS~DE G1TV CiMiTS ` ,Spea' ~es o~ No~ ~ Florida ,~a St. Lucie ,~,Fort Pieroe ,,,1405 So. 33rd St. fes ' ~AT/iER~ N:.ME f~F57 MIDDIE IAST MOTHEA MA~DENNAr,1E FiR$T MIODiE LAST ' Jahn Kuecnenberg ,F Catherine Pitma~i ~ IyFOHtiIA~iT -NAME • T~pe p: Gr.nL MAI~~NG e.DORE SS STREET OR R F D NO C~TV OR 7pW~N SYnTE Z:P _ F~.rd Benson „p1405 So. 33rd St. , Fort Pierce, Flarida 33450 Blip~Al CAEAUTIDN REMOJAL.O?~~£R~SCecr!r~ CEMfTER~O~+CREMaTORV-NAME LOCNTIGN CITYORTOWN STATE _ ~urial St.Joseph's Cemetery Palm Bay, Florida , , = fUNERAL /DIRE -iS~gna~ur ~ ~ fUNERAI HOME AD ~ 32901 I/ ~ • i +4a ~f/"~-f/Cd~l - ~ Cf~G • ig~ Brawnlie FY raa~tv~t=1~ G~1 ~ i ?Oa 70 ces m~ ~ro+•enqe Ae3en cae~ rea a~ tne ~~~^e ^_3te a~o;~'3ce a~~~ aue s 2tn On tne oass o~ o . t n my op~~n~ a a:n occ~~r~o ai tns _ ~V ~o~necs e;sist3trJ / ar nme. aa~e an0 D7a O ~eC , - (5~9^~twe Tqt~) ~ ~ (SiV^aroo and T~ ' ~ . ~E~ DAif Si.riNeD~4eo. Gay ?r J M~,;v~ :F DEA'H CA1E S~GNED /M1/J D~y 1'r ~ - MOUfi OF OEATH n ' b=p W : ~o za M z,o 10-31-84 z,~ 6:18 P.M. M E~ ~ ,I , , oF N~6~E OF ATTEhD:`IG PN~S~C'AN IF CTNEp TNAN CEAT~F~ER r ir~ a p~~~~t~ Ep PRONOi1NCED DEAD ruo Day Y~ ~ PROYOJNCEDDEAD~~+o~~i ~ - _ ~V xO Fi ?16 ON ~ ~O~G7~V~ 2/BAT C7:~~ P.1~~. M NAMc ANO AQC.7ES~i9F CER(1:1EF IPMVS}C~AN MfO~CA: `anUihE~: -Troe or m~~"- - Leonard Walker,MD, 1700 So. 23rd St., Fort Pierce, Fl. 33450 22 - AEG~S7nAP. • ~ OAiERECE:VEOBYREG~STRAR;MO Dry Yr, ~ f.. ~ti~ ,:oNS 7,, ,S 4~•,"0, ~ 2„ NovembeJc 2, 19 84 : r GAVE ~MMEC~ATE CAUSE ~ENiERONL ~ ONf CAUS RU~Vf FpR~a; 'D~. A.YD ~c~ ~ ~~M7r~rra~+Detw7eren ornN and Ceat~ ~ A'~E N~E ?AAr ~a; A~.U1L' ~..L~t'SL~LWGL~.1.71'~t~]L li~['lt.il`Y'i ''i~l.~.L.i.`1t E _ ~ E+a~ I,n~er.a~ eenreer. o~se+ ana aeun ~ ~ -~'+ti ; THE DUE TG OA AS A CONSEOUENCE OF nL~~+LT7 _°~_v:yG ~ ilL.l,I~lvr i _"S. ALTI~O DRIVIR STRll(~{ ANOR.NIIZ ON ROADL~IAY AUPO , f ~ ~ 6UE TO OR a5 A CONSEOUENCE OF I+n!ara~ Oe~.een ons?t an0 ~eatn { ~ Ici ~ ~AIR C'.~;R i+!s'.:F~CJ~kT Crv.~.^,IT:CN~S-C~Otors c~^'O:.^9'o xam W. a~da'a6 •o ca.x ?'•t' .n PwRf I~.a1 /M'T 0 iF Fc4A'_E h~5 T1~ER"c A A~.TCFSY :.L':E R:FEFNeO 10 !a~iJ~C~' ~ ~ PRE~'.aNCv ~N ?nE o~15~~ON !'*5' ..ls EUU:hE~ »s o~ ~rt ~es', No: j.~J ?S ~ % € ~ ,7rppa~;yr ACC~DENT SU;GDF pr DATE OF iN,iUHY (MO., Day. Vf.) HOUR Of INJUpY OESCFiIBE HOW ~NlURY OCCURAED ~ MOM;CIDE aUNOcTERM~NED(Sp~ulr; ~ F WAY ~ z'a A~~ z~e -2 ~ ~rc • zia - ~ 1N.;::FY AT W~;flK'Spec-~r P:ACE Oi M;UFV-A~ nwne ~a~T strpeL fat;Ory. 0~~~~Ge LOCATI~1 $7E1EET OA R F D NO C~TY OR?OWN S7ATE ( ~ _ y<i o: .4'~, Gu:40,n~ ett ~Sflec~f/, ~ -_~_1z`'~ RO~Y OI~ECHOBEE AI~'D H~~ RD. FT. PIERCE FL " ~ ~ € ~~~ereoy certity tttts to b~ s true an~ coerecr copy ot tna ~oca~ ~ ~c~isqrar's re-ord on File fn the S, _ Nealth Depert- N(]~ 16 ~Q :~7 t >~r~t at Fori p~e.ce, Fiorida. ~ (Waming: Not valid unie~~. ,e : , : . e, Luei~ F1~= ~ - County Heaith 7c. . , •;e . ,s ) ROGE : " . ~ ST. LU:: _ . . , _ N. D. M!LLEi. M. D. L U[1G]4 ~ , • _ Cotxtty Health Oi;~cer b Locel Fttqistre~ V0VC71 ,y . « ~ i ~ • • '-.i~ ?v. S • - : ~ U~1t aQiJ1~1 L.O~C~) Q~Q1.Hr 'f - . , , ' . ~ ~ ~ ~ ~~~x 448 936 ~ ~ ~ ~ ~ ~ ~ ,~;=-j- - .~-3,.,.~---" a~~-~,r..~~~~x~~