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ST 48,188
~ . ~ CERTIFICATE O~ DEATH ~
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DECEDENT-NAAIE i1RST 4SOt)lE IAST SEIt DATE O OEATHfMO. Diy. Y~ 1
+ NEZ D. BOOSER ~ z Female , Au ust 16, 1985
! RACE-eq, Wn~te. &act AGE-ta3t Uvt~~Oay UNOER t vEAR UNOER ~ OAY DA1E Of BIHTHIMa. D~y. Y. J COUNTY Oi pEAtN
' . Am inA~an_NC ISpruNi IYn.! MOS ~ OAYS HOURS ~ MINS
' + s+ sb x e Ma 13 1919 Pinellas ~
C1TY, T01Mi OR LOCATION OF pEATN HOSPITAI OR OTHER tkSTITUTION-Narx f71 npt rn ~,M~r. g:rs street and numpN) IF HOSP OR INST prM~talt OUA. ;
~ ' ~ ~ OP.Eenti Rm.lnpatilntlSpec•ryl
- rb r~ 239 Dewber Lane ,a
STATEOFBIRTHp/not~n C1tf2ENOFYhiATCOUNTHY MARRiED.NEVERIMRii1fD. SUAVIVINGSVOIJSEl~~M'~4.9'r~m.l.d~nMm~) ~
~ ~ USA.na+rNCOanfry~ . WID01MfO.D1YQRCED{.Sp~t~.y) ~
r~ a 9 .S.A. ,o Married LeRo J. Booser
~ _ SOC~AL SECURITY NUMBER USUA~ OCCUPATIOH I~~w kmd o! wort oun~ tlurmy KihO OF BUS~NE55 OR ikOtlSTRY
rnairCJr~rfmy^t:!x rre~~l~ef~ed~
; +a ~s, Hnusewife ~w -Own Home
~ e RESIOEY.CE-SiAT~ CWNTY CITY, TOWNOR LOCATIAY STAEET AND NU670ER IN51PE CITY L1IJATS
~Spury r~~ a rvo~
~ ' ,~e. p' Ila ~k Tar r. S rin s ~.a 239 Dewberr Lane Yes
FA7HFH-NAME i~HST MiODLE LA$T AiOTt+ER-M~ipENNAME F~RST I.nODLE ~AST
~ ~,S Gunnar Anderson t6 Beulah M. Gardner
IN~ORl1AHT--NAMEITyp~oiRrmfl MAIUNGADDRESS STiIEETORRFD NO C~TYORTOYVN STA7E 2~7
LeRo J. Booser ~~b239 Uewberr Lane Tar on Springs, Florida 33589
~ 6 9URUl. CHEAAATION, REt~AOVAL OTHERISpetJr~ CEMEIEHY OH CREMAtURY-NAME IOCATIO~J CITYOR TOWN STATf
,e, Burial ,eb Forest Lawn Memorial Pompano Beach Florida
• fUNEMlD3PE {Sqnaturtl / fUNERAlH9NE Holiday ADDRESS ~lorida 33590
~ ~ P`~ C ~~~o ~homas B. Dobies Funeral Home 1311 PinelSough lane
r ° Yoa to trr eese or m~ ~no.r
~ / M9e. Ctath ace.rre0 ~t Ine Umr. date an0 p!ace and dut 2L On I~e Dai~s o~ e•am~nat~oa ud'o~ ~nreSt~gat:on. ~n m~ op~nipn deail~ occurre0 a1 it+a
~ fotReCaose~slstiled / aW INre, da!e and C~a:p a^d a•x Iu I~! uuse(s) stste0
~ : = (syn.nR. ana rn1~) s-G ~ (sqn.n,r, .na Tw:l P ~
~ DATE SIGNfOI~o. DIy. Yr ~ NOUR OF OEA1N ~x OATE S~GNED ~MO D.+y Yr ~ HOUR OF DEATN
~ W
~ acc " "~J~ aa 11:50 P.M. M v~ a,e z~~ N
~ ;F NAEAE OF ATTEND~NG R1YStCiAN li OTHEH iHAN CE~iTiFiEH 1hPa o~ RiM) =p PRONOUNCEO DEAD rNo Dar r~ ~ PRONOUNCEODEAp~~rp~r~
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NAMERNDAOORESSOFCERTIfIEN{PHVS~CI MEOICAtElU~1~NEAlffypeap~~~~!lSOI U~'J. ALT 19;~ON Springs, FZ. 33589
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iuuiSTRAR / ',.~jj"y. ~ OAT CEIVEO BY REGISTRAR(MO. D+y. Yi.l
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- 2]a I natw~l ~ ~ ',i ~ • ~J
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OUE TO.ON AS A COHS~OiANCE Oi eCot~tiot(8) y~vp r'W to cau6e (y - lis~ ~nd~rly5ng tyiMe Iast) tntcrvN DeNve~n onset a:~G detlA
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Dl1E TO.O~i AS A CONSEOUEHCE OF. T#- ' ( IrtervY DaMeln anset snd dea!n
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~ ~ VA7tT OT1ef R JGMK~.N7 CONdT10N5-Ca+6~ms cora0itep a Cexh W rce rdxe0 b ea»e y,en n PAAT 1~a) ~MT 1/ ~F iEUAIE W.<5 iHFitE A ItUtOPS~ GSE REFERRfD fO ltElkC.tl
¦ FR£~IWCr w E PAif ~ UOr~T~ f f ro/ ExaJlttER .es a rol ~
' res r~rc~. ?'si'YO M ~°h
~ vropaWy) ACCIDEHT. SUtCtOE a DATE Of IN.IUHY
HOMICIL~E. a UNOEIE.°.NINEOISpsulyJ I~~. Day, Yr ) HOUR OF INJUAY DESCRIBE HOW INJURY OCCUAREO
` i 27~ 2Ib 27t M ITA
j~ iNlVRY Ai WORK (Sp~[Ay PLACE Of 6~IJUAY-A1 Aorne. larm, streel. I~ttory, o16ta IOCATIOPI STREET OR ii f O NO GITV OR TOWlJ STATE
y r.: a No) D~na~ng. etc Isqury~
~ ; ?7~ 271 77
~ • - _
t ~ ~s ~JOV 19 P~ :~o .
~ AUG G 2 1965 . .
FILED AHi~ f "~.:;:t~~ ~
A CERTIFIED COPY MUST CARRY THE EMBOSSED SEA OF THE tq~. , STATYSTIC . ;
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r I herebq certify that thi~ is ~ true and coxrect copy of s ce~tificat~ .
' on file in the offiee of-the Locel Aegietrar of Vital Statistiea of the
~ Pinellae County Health Depertffient, St. Petereburg; Florida.
~pe~ty Lccal ~Regigtrer
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