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HomeMy WebLinkAbout0964 s 69~6003 ~ ~~„r~~ CERTIFICATE Of DEATH f L O R 1 D A ~.w r.. 4 20 rrw ~t ~w M~~r~ ~ ~t uu sex o~rc a oe. n~ ~r._ w... , F~tORY fl. SINITH Ma,Le ~ Ju~~ 4~,1979 NI~Gt K ~~~IR) ~ AN-y Mi~~ Vq~ 1 tW 1R1plr 1 Mr WM p~!M plw. Ar. tr.1 GOM.1n p 0lAA1 ~ 5602 ` M~ ~ ~ . .Y6 19Y4 S.t. Luc~e ~ O~?. 1~ O~ i00~~ Or N?l~ ~C~I~tw? 0~ OM! ~M~d+-aa~r /4 rr r.~~. I...~.r..r wl a~ i yF~~ .'~i~.~~i.; ~.t f~t. ~Lt~tc~ h lawwavod Medica.t Cewt~x ~A ww a~ o:w~ or w.T c~ou+nr ~wre. w~~wo ra~e ~a.r. r. w.....~ v~__~c~sJ~r..w~ ~i • a ~fW[J[~(.ea n. 8lA1rltP.t.t i'iaTi ro~n air~t u~wi ocoMna~ n.~. n.r w. ~ao a w~a~ w rasTe. " .i ts~-:~•atso ~ . . ~a~.a aowr an. www a wur~oM we .~w~ ~.da rn• :u.~n I~ ~M/~VM/~li ~A~i~rG. t4 p.i.e~tce IN. C/ O~ G 7~ 11~e tr 1~) l ~I / ~rID ( ~s~t wrr rroK~ u~u ~w-www w~re nw r~oou usr ~u ~ A~C6~t L. Sn~i.th Ann~e Mae Jackdor. n~.. ir.U uw ~oors s~ur w e.r w. un o~ raw~ :-,•t t+ SRi~h 2705 S. 29~ic S.t., Fx. P.c.en.ce, 334S0 ~a~noi+. ~rww?t, oM~ rri.v,~ ctrnar o~ ca~r~sotr-+.wt .ounaw a~r o~ ,o.w sr.•c &~t.iaL Wh~s.te C.i,ty Cem~t FZ. p~,ence F~. ~ ~ ~ ~ ? ~ &IIR~ fUN~'RAL HOME ~ ~ 1~ I ~ ~r w. !1a Ow ~r y~ d ~w~w ~//«r~~, ~ w++• ~eM .r r owa ~s~/ r r nr. ~w ~w1 W~ wd M r r~r14 sar. ~ ~ l~+ ~1 K4/' j f~~ ~1 TIii1' ~ Wf N~ fM.4. nJ p Ofw r?rt iqrl/D fr.. f.J ~O~! O~ Dfwn~ i j ' Jul 26 1979 3: 48 P.M. , . i ~ ~MI~E Or wii~Or~O wll~llOsM q ofr tww CHii?tN (?sn • r+U s~ MoMOUr[i0 MwD Af... I~. f•.J MONda~[fD Ofw~ /rr: t Z g ~ !~l p~ 7r. At r ~ M~1 A10 ~i 0~ ~itYfr AMrO~M. tl~D~fJ~1 RA~E4 I~n~ ~ I~l ~ = Kadivar M,D. 2215 Nebraska Ave. Ft. Pierce. F1. 33450 wn eccerveo a aas~w rrti a~. r.., ~ m~re~o~s s.n...••, ~ , ~ ~ ,e July 27, 1979 eye to X_~n ~wMe [ass~t o~u ors c.ait ~ ur iw / nl. 1w ~.~.1 ~~...~..r b,.~.....~r r ( w"' Massive Myocardial Infarction ' ' ~ r io. ~s. ae~~a~ oR ~...r? ~ Chrenic Obstructive Pulm~onarv LunR Dieease ' ~ ~ w w. w ~s. aoN.w.a o.~ ~ trwM ?a.~.....r ~ M ina Pectoris ` ~~MR O~r f+Y~~1KNR ODrO~T~Or'I~Cwirs ar~~r~ A i~~ ~ ww wbr ~ oir r•r r IMI I M WIO~f? /l~+I~ MIAS UfE MsEefEO ~O rlOKAt s.~ W E~w~.t~ IMc.n Ia ..1M1 ~ s //e x ~ C ~~OOblM~~~ ~ Ml~ Oi otA1r /1w Ar. I.-l N,711~ p MuNlr D~[~y! ~tllM NA~ ORtJrq ~ . ~ r ~ M~n ~t ~ i~.rti s. nx~ a uwr-w~ w^r. w.~. ~outioN tnetr d e.r o. w.. arr oe row~ cr,re .I~W ~t f+r~MiJ ~ !r. ai. ~ ~ i ~ ; r,~.a, c..~rty ,r~ to ee . nu. .nd «xr~ct co~t? at w,. ~oc.~ '85 ~IAR 12 A 9:Ob ~ ~qb~ars reoord on File in tfie St. lude County HMhh OM~• i s L ~ E ~ ~n Pierce, F~orida. ~ . , < . ~ . ~ (W~ning: Not valid unless raised seat of the St. lud~ ~4~~~L;~' ` ROGEC F~ ~ County Health Departr,ent ~s affix~d.) ~.i •'~~l r 5T. LUC . ~ ~ ,r,K~ fi~.~fs003 ~ ~ N. D. MIIIER, M. D. ~ , ~ Gounty Health Off;cer 6 I~th' ~ y _ ~ • - .~'.~~3. . . ~ ~ ~ ~ . . ~ , ~ ~ D.p,,,,, Lou~ ap~ ' - . ~ iiR 1Cn !~!'1A