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CERTIFICATE OF DEATH ?y
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Mu~plpprt QEGEDENT-ru~aE i~RST 4~:001.E I~ST SEX GA7E OF DEATMiMp Dar. r.1
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~3TM~~ ~ Herbert James Blakley ~Male ,May 5,1986
/ MCE-s q. Whte. &st~ wGE-lut B~rte+OaY UYDER i rEA(i t1NOEH i OwY DATE OF B~RTM/4o. Oay. Yr ~ COUNT~ OF DE~TN
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White ?9 °S ~ °An x ~ "'N5 aJan , 8 190? ,~Seminole .
~ CITY. TpWN pq lOCA11ON OF OEATH Mp$ATAL OR OT1iER ~NSTITUT1pN-Nain! Ill nor n wne~. q.w unH arp nfrnO~r~ li Hp$p Oii IN$T ~ InO~cate OC
Sanford T~ Lake View Nursin Center a'I`npat~'en~°~`~'
7~ SiATE OF BIRTHillnd r~ CITiZEN Of MMAT COU!lTRY Ml1RqiE0 NEVEA MARRIED. $U(iVIVWG $iQUSElIf wN. y~r~ myp~n n~~
U S s. nanw taunrry~ Y1nDOWEO. ONORCED ISpc~yl
• s w erse 9 USA ~o Married ,~Rose Matero
8 SOCU~ SECUwTr NuuBER USWI OCCUPATION IGMY.n001 wOrk dpry Ounny Kif~ Of 8t!$iNE$$ Qp lNpUSTRY
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~z U61-07-0370 Retired~~ice ~iac~`ine Mechanic
RES~t)ENCE-STwT: C ~IA+TY CITr. TOwN Oii IOGATiOIV STREET ANp NUygER ~t1S~(~ dTV ltMi'
14 Florida Seminole ,k SaIIford 5??5 North Rd. ~S°"'"~o°`"°
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_ FATHER-NAyE FIpST WOptE LAST iJOTMER-WUpEHNAYE FIRST WOOIE {,A57 ~
' ~s Richard Blakle ,6 Rose (Unknown)
~ • 1MFOiWANT-NA1yE (T~ y Rr~f~ YAI~ING AODRESS STREET QR R F D NO CITY Oq TQWfti
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Rose Blak~e 5??5 North Rd: Sanford Florida -
.i • &XiUI.CAEWTION_qE VAI,OTNERI CEYETEA?ORCAE1WTOqY-NAME LOCATIQi CITVORTOWN S7ATE
° ~ Cr ion ualit Cremator Ocoee, Florida _
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_ ~ ~m? ~ ~~risson Guardian Funeral Home 905 Laurel Ave.
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= {~O OATE ~f~EIIrYb. W?'. OF DEATN ~w OATE SIGNED ~YO. Oa~. Yr / MpUR pF DEATH
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NAYE AND ApdiE$$ Qf CEATIf~f ii lPHY$lCiAH. MEC4C/!l EIUIJ~NER1 I~rOf Or p~nfl
- n Charles W, Hardwick ~ 712 W. 25th St. Sanfo~d, FL 32771
: PEGiSTRAR OwTE pECErv£O BY aEG~57RAHl1vo. Dar. r ~
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• OuE TO.Op ~S w CONSEOVEr~GE O~ ~ tmerra+ eesree~~ oruet ana aea~n
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iPrawc+yf AGGDEM'. SWG~E a pAIE Q~ INJURY (Mp.. pnr. Yr ) ~i0(JR OF ~WURV DESGRIBE MOW ~NJURY OCCURREU
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WJUQY A71NQpK /SpCAp PCACE OF NVJ(,)qy-M ~dr~~. lirtn, strNt fKtOry, pM~ce I~CAt10N $TREEI' QR q F O MO GTY Ofl tOWTI STATE
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as Of 12~1-84
C E R T~ F I E D C 0 P Y
I hereby certify the above to be a true and carrect copy af the Local Registrar's record
on file in the Seminnle CounCy Pub~ic Health Unit, Sanford, Florida.
This copy NOT VALID ~:~less raisad seal of the Seminole County Public Health Unit is affixed.
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