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~ ~ ~F ruar 22 1986 ;
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CITY, TOYvH ON IOCAT~pH pf pEATM NOSMIAL OA pTHEq INSTITUTION-Nam~ (II nW ~n «~Mr. pny i1nN rn0nwnpMl IF HOSV OR INST ~Ind~c~i~ OOA.
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MKOR4IANT-7~lafdE(lrpOOrArM/ M/UtIMpA00AE5S STREfTORRi.D.iiO CITYOATpWl~ SiATE ZIP
- lliam Koo caan »b282 Sout East Walt T r ace Po t St. Lucie Fl ~52
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- `~'''E"""~° ' s~~, f~"E""~"o""fRoger L. Byrd Port Saiet4~'tiAcie Funeral Home
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~ OATE 510MED/Ala, 01y. ri.) Of DEATH DATE S~4t~JED fYO. Osr. Yr.) rtptl~l pf pEATH
~ Feb . 24 1986 11: 30 a. M z,.. a . M
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~ Fi~luv~cy 24, 1~38~i
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1 1 ACCIOENT. ~tCWE p pATE OF IN,R161Y (Ab.. p~y. Yr.) MOl7R OF IWUNY OiSCitlBt 1ipW IMlt~IY pCCVRRED
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