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HomeMy WebLinkAbout0970 ~ ! ~ . . - ' CERTIFICATE OF DEATH '~1~602 j~ ~ ~rVf LOCAI itlE NO r~ v~~ STA1E i1lE MO aCFiNT l~~f~fli N: h~ fs:4CK ' F Mk 1UC,1 A~~.::.;.i 14•.1 •.la Uw~f ~i~ i.ERr~~ lr„ J.~~ . ~ I tE , Cenevieve R. Cornwell .Female ,Sept. 20~ 1_984 p} •.~\O800R I sVq HA(.F ry Kr"~.~ kl~.~'~ Ai:E lr,1Nr~•~I.~. t;•ai:f{1f it0.:~ ..!.I:ifltilw-f-T[lAlf ()f llil/i~~.\I;~ !>..r T~illNir~~f (,E~t~~ - ..ra.:~a,T~ONa n~~ i~..~..,. .r~ t;<•,,, i:,S ~ [:a.. .,;~~,W, M,N~, ~ ~ . White 69 ~i_ ~ Oct. 2~ i914 I,J St._Lucie , 6603 CiTYTOYdiURIOCA[IONU/UE~!~: 1~*x:~iqi,7NfrtW`.TtIUT~i:N Km.~,:!~.,u.,rrn~v J..r~i.r.r.n~.r.,..~,tr•~ t~.,,.?.,N~tril ~•rDU• ; ~r.~ E..~. ~ ~ ~i:t+.l~, ~o Por~ St. Lucie Port St. Lucie Hos ital i~tient S1AiE0~lfiHJ~~~~ „n; C~I~:EN(,~Pn~4?~:7'~~`~tN• r,~4FHIF0 NfVERMARHtEO ~IiRL'~V~N,4PUUtiE~~rw,~e q.e•~..eae=n..-.. US4 ~~.r.. .~...,,r ' :.~D7NE0 OivORCEO:S:n..rr~ _ e 9. :.i i~ ~ ~ ii.i~~ SOC~AI~ECL:R~T~M1tUMEtER uS~;a~~!~.-.~vGq*iU~1~G,.r~.,u~c•.,n~,i..~,.~d~,•.~~,J MiNDOfHUS~NESSORiN!;u-.tar • f• ~ nunl ot ny ..rr t.rn .1 , i«~l~ ,i0'!vK - „ 088-07-b260 House-Wife Oxn-Home ~ c,~. nF - ~ ~ E:TEti~3 AEJIDEhCE STATE COU~~TY CiiV TOJYNOR~OCATION STqEEI ANDNUME3EH ~NS~Gf C+TVt+MRS F'lorida St. Lucie Port St. Lucie 108 Lobster Roa.rl ` rio H~' 1~~ 1~D 1k I~J + GAINEA NAME iiH$i M~DOiE ~AST r.+!)1~+ER !fAiUEAINAME fIRS~ M~DDIE LAST _ t5 Charles Ball Josephine Gruber iNCnRMANT . NAyE ~~rDe O~ Pr~~r, ~,~a:~~ti.ri ApDRESS iTHEE 1 C;R i~ i p N0 C~~ ~ OR T04hN STAtE 1~~ - Joseph Cornwell i._~ 108 Lobster Road, Port St. Lucie, Florida 3345z , BURIAL CAEMATIOtV REMOvAL O1HE~~ Sc+r:~r, ~.~EMETEa~^~~CFEAUTORV WAME IOCAi1pN GTYORTOYrN S'~iE ; Removal~Cremation ~,~,Wallace dc Khite Cremato Stuart , Florida _ , _ FUNERAL D:R TOR ~5,~•~a~u~ti A ~ ,f V•JE.~:.: NCNE A HES Roger L. Byrd Port St. ~uc~e Funeral Home _ ? ~c.~ ,7~ . ~ - t ZBa io i^e Dest a1 m~ ~cew enqe~aeat~ occ~.~~e7 ar t~e t~~~ Ja•r a-~~: n'ace ano.J:.r ?U On ~ne Das,s ot eaam~nat~en an~ o• ~n.est~qat~on ~y co~~..ar+ OUtn or~,:,.M a~ Ine _ ~`V Io1~ecL•~s~.sl f:a:?Q _ ~'W ~~r*+e tla:e a'+A pqce a~ 0 te Ih! U~S!~sl sta•e'J _ p} (sp~.W...nATM.,~ : (SW'.tw..'w.~tl.,? n~a tlO ~W ~ ~~a, DwtE SiGNED.M, D~, r, i rO;:a O: CEaiH % u4.~ v. ~ Dar ..n~ iw nc pEsrH _ , 6: 30 P.M. M ~ T'~a z,: n~a M - > = E~= NAME OF ATTEN7tNG i~r+vS~C~a ii pTHEp THAN ~ ATIF a-I - oY Pq7Y0UN~ ODE~D-HC~n _ o~ N E rM or P~~~r, =p Pq0':vu~+CED DE~n ~luo Ds~ ~ _ ~ W . n~a ~ a n~a n~a V ? o 0 2, o O N AT pp NAME ANb ADDAESS OF CEa; ~~~ER •.o.+rjiC'AN MEC'C-~~ EX4MINEA~ ~ l~pe o- a~r'- - ?2 Kenneth S. Frieur~an MD, 00 S.Ej-iill~~ioor Dr., Port St. Lucie Florida 33452 - - FlEG!STqAR ~ DaTE AECEiVEC Br PEGISTqaa ~ MO Dar Y~ ; ._~,oNS Z»•~~.~~-~~? ~3oSeptember 25, 1984 } a.,~ - ~^AYE ~j ~MMED~ATE CAUSE ,fh ~EAG~vt +Ghf CAUSE of ' F FOH ~Di AkD; c~ } ~ ~rte~.i~~ Detwttn o~st! a~tl 0eat~ = iE 10 ~AIIT Ia~ ~ ~ ~ 1 .~~cpi~TE ~ _ ' / . - _5~ ,s~ 1 ' - - ' C ~ • -^''4~ ?NE OuE TO OR AS A CONSEOUt'MCE C~ I , ~.e•.a~ Der.een a+se+ a~a aea!n - -_Q~nNG ==_iELAST 1 oi I DUE TO OR AS A CONSEOUEMCE O~ {~^~•r.~• ~ewee^. orse~ a^a ;ea!~ ~ ~ ic~ ?AIYT U~.•ERSGti~F~C:vr'.+.G'~.> rvs:.- ~:xa'•.~ ,•ba'r~•o a_sr~y~r'vNis:~ar ~MTW.FfEMi;E .~cS:.~~:c4 ,'~.'~5• oE%E:.~EUiCr:c~~'+' ¦ c~~:; .~4"• 'HE c4i' ~ M~:~.'~S' ..s ~O ~ M.'• i1V ` ~oe't'. ; .cK . 'ui ~T~" lc ' (yrppaD~~~~ ACGDfNT Su!C~DE o~ DATE Of IHJURV (MO~. Dty, Yr.) MpUA O~ ~N1:JAY DFSCA!BE r+Ow ~N:uA~ OCCUpNEO HOMICI^vE MUNOETERMiNEG~Spei+~+ _ .,2 27a 2~D :'c N ?7d . qe~;~~ ~N:UAY AT WOR1S ~SpK~~Y F'I~CE OF rNJUfl~ A1 nr~.Te U•"~ St~ec' ~a~t^ry o~4~~ ~OCAT1pN STREE' OA R i D NG C~Tt G~ TOWN S~ATE ~ef o~ Nor D~:;.f~~,q n.C .~S.r-'c,~~, _ e.~•~ ~ . _ 5'Z: 17e ?71 '85 ,AI~ 24 P 1 :48 FI~- - . ~KY ~hb to be a tru~ ency corr~cr copy ot tne ~oc~, ~G~t R~Okir~s raoord on fil~ in ths St. lucie County Hseith D~eh ST L~!~': ~ ~n~tK et Fort Pi~rca. Floride. ~~t~~~q: Not valid unl8ss raised seal of the St. Lucis `~vv~~ ~MY ~I~h Dsp~rtmern is affixed.) " ~ , N. D. MIIIER, M. D. - - ~ Col+nty Health Officer d~ L al Registrar ~ ~ ~ ; t , , - . , . . ~ ~l.'~T '~/,1~ i / . ~ ~~y i V ' ~/~ril ~~I«I~~ ~ . ,;K~71 ~ . 9!~OK P3GE ~ . - _ _ ~ h.~,