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~,T C~RTIFICATE OF Dl•ATH ~'~5463 ~
"~"'~"T FLORIDA
R~C~ ~K LOCAL i1lE NO.
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nt.,~_,gppK DECEDENi-N~ME PiAST MiDDtE IASr SEx p~TEOcOE~"ir+;vo Car r~,
•.~r~~~S i, OIIYER L. StiAW Z Male , Ju?~ 31,19~6
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. ~ x 6 Januar 26,1912 '7, Martin
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-~o Stuart ;r Martin Memorial Hos ital Inpatient
, STATEOfBIqTN~Unp/m C~TIZENO~K'HATCOUNTRY titARR~ED NEYERMARHtfD SURYrvWGSPOUSE~~~w,h q~.~m~0en^im~, !
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- e Penns lvania 9 USA ,o Married „ Edna Jon~s
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RESiDENCE-STATE COUHIY CITY TOKN OR IOCATICN STHEET ANO MUMBEA iNSiDE CITY UMiic
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Florida ,.aSt. Lucie ,kPort St. Lucie ,.a26 Lake Vista Tr. #1~1 No
_ ~ATHEFi-NAME FIRS7 MiD~iE IAST ~~~iNEp- ti~+~DENNAIA~ F~Rjr 1riQC,E LAST
= ' ~5 Bruce ShaNl _ Bessie Rogers
_ :NfORMANT-NAME iT~pe o~ ~r,nt~ ' MAi:iNG aDJ.7E5S S?REE' OH q i D ~t0 C_':Tr GA 'O.tiN STrTE LiC
` Edna J. Shaw ,;~26 Lake Vista Tr_ ~101, Port St. Lucie, Fl. 33452
• BURIAL CREMATIpN.qEMOVAL O~nE:-~Soe~!. ~CE4IETEA~CpCAE~ATCqr ti4r.~E ~:CCAiiO~~: ~i7vC~lTOwni STA~E
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= te~ Cremation Ft. Pierce Crematorium I~~ Fort Pierce. Florida
= s FUHERAL DiR C --r55n~r~r `i ~~uNEAn~'+: ~~E ~DDQE55
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_ ~9a - >>o Yates Funeral H~m _ Box 777, Fort Pierce. Florida
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, ~ $O~ DATE S:G EO(M D y Yr 1 HO R OF DEATH aFu DRTE SIGNED ~MO De~ T~ ~ kOliR OF DEATH
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EF NAME O ATTENOING R+YSIC!AN fF OTHEQ THAN CERTIFIER ~lYpe o~ P.~nn EO GRONQU\CED DEAC (MO CeY i PRONOv:CEDDEADrNpu.r
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~ NAME AND AQDRESS OF CEH7IFlER IPHY57CMN MEG~CAI ER~MWER; I ~YPe o~ D~~n;;
Z, Daniel S. Dennison, MD, 1038 E. Ocean Blvd., Stuart, F1.
AEGISTRAR ` DATE RECEIVEp BV REG~STFAFruG Day Yr ~
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~?~otaC'ry~ ACCiD~NT. SWGOE w DATE OF INJUr'iY (MO . Day Yr ) H^uA C~ ~^~~uRr i ~ESC~~BE HOw ,h;~,;Rr OCC~aaEC
MpMICiDE. c~ UNDETERMINEO(Spsc~~y~
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~ . . . 2-31-84 - -
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~ I hereby certify this to be a true and
~ ~ correct copy of the Local Regis[rar's
record on file in the Martin County
~ ~ " Health Department in Stuart, Florida.
Y •
- (Warning: Not valid unless raise3 seal of the
~ - Martin County Health Department is affixed.)
~ . ~ .
~ • . . .
~ ' Kathleen Muller, M.D.
~ County Health Officer & Local P.egistrar
~ , . , 3 i ~-~`l . st~~~G.r..Q
~
ate ~ DEpu Local Registrar
~ ~t~~i ~ ~ ~2 ~~6
~ '7'7~463
R~~~~ - $op~510 ~34
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