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T'T` CERTIF~C oT~E+ p A DEATH ~41631 /
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N~NpppK OECE~Ent--w?rrE c~R3T MwO~E lw3i SEu WTE OF OfJ?iH1YO. Dar. rr./
, Henry Minter Hubbard ~ Male ~ecember 28, 1985
6699 nwcE-. wrw.. su~. ,?c.~-uu sr+~o.r uNOen u+oEn , w~ OATE O~ e1RTN fAb. MY. rr I caHnr oc o~?n,
M, rar~.ec rsa~.Mr~ rr•s ~ Mos. ~ wrs ~wuns ~ ww St . Luc ie
. iihite s. 89 x a June 7 1896
CITY. TOWN 011 LOCATION OF OEATN HOSOlTAI OA OT11E11 M/STITUTIOM-/Wti (Y nW n MMw. Onr~ a?nN ~n0 n~rrM~r! IF MOSY OA INST (IM~pM OOII
~ OP/EiMi. Wn. Mp~ylSOrtfpl
Port St. Lucie 157 Soneto Court „
~ STATE OF B1RTM fJl noe n GTIZEN OF W/NT COUNTRY MARR~EO. NEVE11 YARRIED. SURVIYWG SVOUSElI/ rA. pr~ ~wrtl«~ nrw~)
USA. nwtaMapl WIDOWEO. dY011CE0 ~pcbl
, N. Carolina , U.S.A. „ Married „ Elsie Dave
SOGU?L SECtJR~TV MuYBER t1SUAl OCCLPA7 WN tQ~w t+nO W rw? a~ory durrg ~ K1F0 Of BU51NES3 OR 1NOUSTpr
rno.?a.«t~c wa .w~ s nw.s~
,2 282-10-5159 Self- lo ed nufacturer's Re reaentative
neswencE-sr~~ c~x+Tr CITY. TONR/ OR LOCATION srneEr ~u+o ~n uu~n¢ cm ~wrts
Florida ,.e. 3t. Lucie ,k.Port St. Lucie ,.a157 Soneto Court no
FATNEN-HAME FMST YIpOIE U3T - YpTMEi1-YAIOEN NANE flR4T ?tqOLE LAgT
Robert Hubbard ,a I.aura Minter
MI~ORI~ANT-MAAIE /Trq pr Rrri YAlliNO AOC~RE53 STREET OII RF.~. HO CRY pq TOWN S?ATf ZIP
,,,Mrs. Elsie Hubbard 157 Soneto Court, Port St. Lucie, F1. 33452
, SU111AL CREWTION, i1EypW1l. OTNER fSpc.h/ CEMETEAY OR Ci~YATORY-NAME IOC•AT1O.1 CITY pi TOWN STATE
~ Burial ,$illcrest Memorial Garden ,k Fort Pierce, Florida
T~-+ , f~+~~ Roger L. Byrd Port &t.~e Funeral Home
_ ~ 7664 South U.S. 1, Port St. Lucie, Fl. 33452
2Ca ntir at ~ e~. WM aiW ~rW M 21~. Oe eM Dars d sa~wreon arA~o. ~nwr~pnwn. ~n mY apimon O~Mn oeourrW at tlr
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DATE SKi DIYO.. . Tr.l MOUR TM OATE SlONEO IMO.. Oq. Yr.) HOUII OF DEAT
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a ~ 10 ~ P ~ t~e. n~a tu M
~ t~UBtE ~ R1YS~CUIN ~f OT?~ER TiAN CERr~i1ER /1~ or hw) ii1~ONOUHCED DEAO rYa. Oy. r..l ~ONOl1NCE00EADl~tar/
~ NOUHC
100. n~a =10 ON n~8 21t AT n~a M
WWE AND ADOiiESS OF CERTiFtER ~VNYS+CuN. YEpCw1 Q~NEA) /T~ a p'rrl
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REG~STMn DATE RECEIVEO 8~ REG~STRAql4to. Dey. Yr. )
z~.,s9~..,? Z I` ~ Januar 3 19$S
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,e OUE TO. OR AS A CONSEOUEMCE Oi ~Ca+QOOn(t) iMticA pti~ nN 00 e~uM (~l - lat tnd/Irnp e~uM WQ ~~MrY W~wNn onsN rM tl~aM
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~ oue To. on tis A coWSfouEno~loc 9 1 ~~Mw w~...., ar.~ .ne ewn
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~ART OhEA 9G~1GWT C~OT~OM~COM~O~ti oOhEt~np D d~~ dt n01 n1~O b v~ pw~ n?M11 (y ?MT ~ s fE?w.E wAS n+EpE ~ ~ui0?5+ GlSE aECEt~qED i0 4EOC~c.
PREG~iMIC~ N TnE PAST ~ MONT/6'' pw a^cl f7(AatWER (SO~c.+h lp d rol
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(~~+ehl /~CCiOENT. SlNC~OE w OJ1TE Of INJUFiY (1b.. O~r. Y?.) ?~OtM1 OF i~1JURV OE9CR~8F HOW tNJURV OCCIJRRED
~ , ?iOM~GOE. a uNOETEManEDfSpwy)
~ s_ 27a Z1D 27c. M 27A
4.- 512• IN,lUNY AT MfOpK (Sp~edr VU1CE pf W,IUAY-AI IfOen~. lann. ftrrel. fatlory. Olhe~ LOCATION STREET OA R i. D NO CiTV OR TpWN 3~ATE
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~ n~?e+~y oKtitr ma to t~e s trw snd aon«t oopy ot m~ wc+~ •g,( JAN 13 A10 ~09
R~qislrars reoord on f71e in the St. luci~ Cou~ry HMhh DepaA• ~
riNnl et FOrt Pierce. F~c• ~a. " :
(Vllsming: Not va~.~} ~~~iess ~taised,seat~of the St. Luti~ F~"
Counfy Fioaiii. L~epr~rFn'.sni 'K aifi~ed.) , R~G'~ r_
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