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HomeMy WebLinkAbout0973 ~ ' , f . i ~ ~ ~ ~ ~ , ' . r 1 . ; . ' ; , ' _ ~ ~ ~ `~J~ , ' ~ ~ ~1°~~"~"'~ C~RTif ICATE 00~ DEAYH _ FLORIDA ?ouinuno. 382 v~n~ n~nse~ oettot?rt-~wre rx~t r?oou ~ u~sr ux o.rt o~ ot.n~ ~ v.. a,. ~ O~ iflM ~ +CNARLOTTE A. VAy ~ema.ee ,.luPy 2, 1979 ~ 'I ~t~c[ uac uct-~.~.. w~w_ wd. ~G!-~.r wr~.. ur+ot~ ~ vu?t uwta ~ wr Git Oi ~1tTN /M~.. An. I'~.1 oour+n or oun~ } ~ ~ GI ~~u,te ~7~ ~ k - .Oc,t. 8,1405 St. Luc~.e 6 un, IOW~! d tOUT1pN Oi MAM /q6Mi~l Ol 0111t~ IN{fiNtqt~-No.y f~/ .r r.. K..a~ ~.f r.M.l ~UY Ot tMi. I~+d<a+ PC• a,~~.n.~, e~it ~ f.t. P~.e~iee Lcu~uvood Medi.e.cee Cen.te~. ,d ' ;iATE O/ M~M IlJr.w. ~s1 C~t12~1 O/ W1NT (OIMIttI W1lRtEDd. p~VOKEOtl1M~lf) ,SUtVm~Xi fl'OIKt Iry ~:1.. I+~ rfn w./ i Cctl.c.~onn,ca USA °°~an~r,c.e.d Ro6ent N. Vay, Sri. s t I~~Ot~M 3~~A? fl~1R11~I ?4YY[t {q{Ml OCMAl10N (6W 4d N wl IMr Iv.y [I/O Of fuSINF56 Of IHOIAttY j anmo•~ crv~ ' ~,~~,aE 004-28-6940 Nome Ma'~'e~e`"'"`".."""""'" „ Own Nome ~ ~[YLtNQ-iiATE f0{Mit C~1Y, ipWq Ot lOfAtlpN itfEt uA NUMiE! ~ti10t C~ttl UY~tS L--~ F.eon.i,da ~ S.t. Luc.i.e F#. P.cehee 1908 S. 35zh Sx. ""`!Vo"",.' ~.a ~.d iAMI!-JM~I! NtlT MlOpt! lAS7 1Mf!-lAAIplN ~UME ~~K~ Y~t~ ! \ ~s. L'~lAh.e.2b $CthC~Q,~ ~s. NP.Z'.t.(.2 S~lUCf2 - iwRW~MNT-+NNt /1~. r 1.ir) IUHG AppfF33 SI~[Fi O! ! i D. NO. Utt O! iOWN S*wtf Z~~ 2 RObeh.t N. Vay, Sn.. ,n_ 1908 S. 35Zh S~. F~. P.~.Ph,Ce ~ FQ. 33450 ` w.u?. ae.Mr,a+.li~OVA~.O1MEt fl~.s.1i1 CEMEtER O~ Ut+r~/WV-turC ~ouua+ c~~ o. fowti s•~Tf F.t. P.~e~cce FE. ~ . Buh.i,a.e P~-ehee Ceme,teh.y i i RAV[t~ qtKT •1 1 fG! ?Or[ ~ ? i ~w. BAIR1~ F[INERAL HOME ~ ~ . ~ 70n.~T..» Mp.~ ~w? ...s~A.mnnd W dn. Zt.. On hr ?u....~..e~w.ae.wn.ndh..wwaya an. •+R7 ~an.a, d..~F F. M~rd Aw M M /~wd. ~ ~ xcurW e~ Av [wr, bM end i~ ad du~ ~ Mr tan~l~l roW- , ~ ~~i........ ti~4l I C s ~ ,S.(..,..I ~Ju,, . pAiE LC~+lO /Y~.. Oy. 1'•J O~ D[~M . ~ WtE LG~+tD IY... M. I'•.1 MOIrt Of OF4r11 , ~ 7 l /A _ ~ ~ ~ ~ ]Oc. ? V N Tb . 21c r f - j~ fMYE Oi TttNOtHG AI?SK~AN Ii Olftt MAH CEttiflE~ /1~~... ~.w1 S~ ?~a7~P~CFO OE~O /u~.. 0.~. 1.J I~O~O~X~ED DE~D ~x..•~ ~ ~ a . ~ ?Id. ON 21~. PT r • ADOR~6Of CEtil O~M. Mf01fAl EIUMfNfq / rrriul ' ~ ~ ,C , V~c 1 ~ ~h; d~ , ~ L I~ . * f -9- ~~t c c~. ~ ~ o tEptf ~ ~ wie ecctrvm ~r tee~srewt ir._. . r..~ ~?,a,d n.. i.~...,.,? - C'. ~ S~, r~. July S, 1979 . W1~01 G~VE , ~+t CAlbf • IG~iL1 Q~11 df[ C4,~si' I[l U.rt IDl /.1. f11. ir0 !d.] 1~"'~"'Of M^..~.n end d.e* • ~wMEO*~ f fAft kl ~ `J.. A 1 - CAU6E b) ~ l ai iV t~`t~ 1,0 Y~,/ ~ 7 1 ~ ' , tTAT1~iG iM( ~ A ~~fN(j U~~lv~~ IMSm~ b~~ o r e~d a~a~t GUSf ltiSt ~ I ~ ~ '~1? ~ ~ ~c ~ ~ ~ ~ 3 l~ ,~Q ~ i ~ ~ w ~-c..,.. ~ c~~~-~..~~ ~ d ' , ~iL~_. ; /~iT 0111Ef S~Cl~lfl(ANi CO1q1T101¢.{rd.rror n1+.~N:rq» dpw bN wM h1eY0 a~ew p..nn ~n ?Atf 1 NI AViOISY /S~wll~ WAS USf ltiFl~~D t0 MFD;UI p . • ~qh [rR?uM~ Is•«p In r~.~ _ 2S. ~ t. p~aleYtrl ALCtO(M.9U~CWE w DAtE Of ~NRl~~ ~M...0.r. I..1 ~qUt Oi iNMY GEW i~E ~qW ~HMY eFD ~ IqrKtOf. ~r UMOffl~~~+EO /SM:h1 . 1f~. }~a M 77d. i - - - ~ 1lih.+. S~I. A1 WOf[ /t~ ln ?lAC[ 01 ~Nrilt7 ~~,Iw~~b~. aw~.r. le~r.r. eNK~ be~ld~+o. ~OU/~OH Si~f[t Ot ~.~.0. W. Uir~W iOwv St~Tt - N.. IA~ Ib• ~ ~Vf~H7! pl- ~ e } Ot 1~10 LOCiI .„Cre~~y cernt~~ this to~ be a tr~e'a L~`~erCountyPl~ealth DeP~'~. ` Regist; ~ ,,rc# ~~,e in the . ~yp s~ ! ment - • ,rc e : .:,~y , . . . _ ! v~~1a7~ ~ ~ .e: eL f ~he St. Luel~ • ; (Wor:; ~;Cr ,,;,~F=; ; c -i O ~ . _ Co~My Heu:;n Dep~rt~ ;e-,t is aff+xed.) ` , ~ ~ - , ~ N. D. M~LLER, M. D. ' . ~ SEP ~8 A~O ~~9 - Gount Health Offi oc.~ R~+s~,6s ti~~ • ~ _ • 1~' ~y - ` ~ ROG;_ v I R~Ai trtx K-_ ST- L„~~: : p p~p~rty Lxo , . ~ . i i ~ 1 s' ~ BOUK f'i,GE 9~iU ~ • , . , - - - ..:__.~u..,.~,_„z., . " • . - • y • - . ~