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HomeMy WebLinkAbout0962 , ~ . ' . ~ - f f ~ ~ ; , , . , ; , , . i ~ ~ ' ~~7f~~~~ E CEliY1FIC/1T1E O~ DEATH ' r?~~ . 1$q 1~ t O R I D A ' ~ y ~yydpOppK OfCEOiHT-NAtJf /IRlT 4110D1E UlSi SEx OATi pi OfATii~itp. pr~. Yi ~ P011 ~ ~ ~F ruar 22 1986 ; 6V~7Z RACE-~q. ri?rN. 6wc~ ApE-lMl BM~61Y 111~fl1 1 YEM UHDf11 1 OAY OATE Of ~{RTH/yo. QaY. Yi.1 COIJNiV Of OEA~N ~ ~ Mn UfOsin. NC (SOK~~YI f Yr~ / NOS ~ . ~ ~ OAYS HOtIliS ~ MIHS x s e CITY, TOYvH ON IOCAT~pH pf pEATM NOSMIAL OA pTHEq INSTITUTION-Nam~ (II nW ~n «~Mr. pny i1nN rn0nwnpMl IF HOSV OR INST ~Ind~c~i~ OOA. 7~ OV;Ems~ an.l~pal»MISV~cdy/ ~eRe s idenc e 87ATE pf gfRTNf~lnpf ~n CiT~ZFN OF WNAT COUNTRY AtMpiEO. HEVER?tARA1E0. SUAVIVtHd EP<3USE//t~~4. p»a~nWwinsm~~ USA..n~counnyl • W1f00Y:sO.Ot5i0ACE06~s::tyJ 0 o io ~ ~ OYt~A ~ . SOCIALBECUAITYkUMBfR U3UAlOCCWATIfNYfOnv1~OM~o~+FOaei+Owr~p KINDOFBUSif~$SpqINOUSTNY _ mW f ol ratwp M~. evtn J r~lrro0? ~s. +x n Researve REd+OfNCE-STATE COWITY CiTi', TOWH OR IOCAT1pN ;TqfET ANO NU~lB[R I~i310E CITY U~AtiS 1~ Iso+ah ra or Nol Y +u us +a P L 1e +~a r Ye s ~ fAiHEp-HMIE FIAST AHDD~E LAST MOTMfN-AtAIDENNAME fIR3T YlOOIE U18T ~ +s r G odin ~s McMaste~s ~ 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 6(JNIA~.~WITION.RE4qYA~.OTFIER~Spit.fyl CEMEiEAYOHCHE~tATORV-NAME LOCATIQi GTYOqTOYfN STATE +a emoval Cremation ~etWallace & ite Cr +a~ a F orlda - `~'''E"""~° ' s~~, f~"E""~"o""fRoger L. Byrd Port Saiet4~'tiAcie Funeral Home t*• ~ 7 64 o th U.S. #1 Port St. Lucie. F1.. 33452 ~ ro u,. ws~ a mr r,~c,w+~e0.. occ m. am.. aw .~+a w+c..~+e a,. 21l On IM DYif W~apniNGOn ~nyOt ~yt~tlpn. M my Opnqn dNN O[tcXtlO ~1 IM ~ f0 tls~ txy~(~) NtNQ. / _ a tY+N, d1t1 uf0 C~ r'W 0w M VM CatiM(~l NsMtl. {1~~~nATlw)~ -~~Y~ ~~iC~Y (~~T~, ~ 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 ~ E ?~IAA~E Os At7tNpW0 pHY6~CiAH ~i OTNtA THAt! CERitftEq fTYpa o~ Praw/ S~ PRONC%lHCEO O[AD /NO. Qer. r~.J pRONOI~VCED ~EAO(HOw/ a": r - ~oe ~ A 8 a~a r~ ~r fl 8 u ALA~tE AND ADORf 55 Of CEA71FlER (PMYEtCfAN. A1E CICAL E%AMIfiERI / T~ a p~r.l/ n n o Ebalo M.D. 1 N ll~to i 2 ~d~T~ , , DATE aLCEiYED Bv a[O~STRAR(Ya. . n.~ ~ Fi~luv~cy 24, 1~38~i n.. rs~+a~..~ ? r~e. tNM[aATE 3E {~N1EAOlJLYONf CAUSE Pf LIKf FpR (A). M/D/e} ~ . ~~,y p~y,~~ ~~~q~ ?AAT (q lr'e- ~~~'"4.~" Vf..i !G~''"'~ ( 1 ~ ovE TO. oR a+sEOtJQacE oi: (Cer~o~:) »fia+ ris. w eaa.e (a} - LiM t»d~rhAnp ause aiQ Mea.M ahrs.n oro.r.~w aa,rt~ _ (b) C~.r t~L ~ ~yA,R,.,,..~~"~ , - ,1 -~1 OVE i0. OR AS A COMSEWJENCE Oj: I tnarva b~hhw+o~+sM aM O~atn ~ u ~ /~I /~uf' ~LC~~` /.•1 ~ ~ ~ IAR7 O7i+fR S~GMSiC/l~t CO?~pA0k5-Conesw Cora~AAr~ b detl+ but rot rWbO b ca.s~ pw+ n/N1t 1(y ?!~T ~1 f fEMAIE. YYAS 7HEAE A AUiOpS~ CJ~lf REiE~~IFEsDo i0 uED~G.I : 27f ~ ?~~c3wocr ~ ~?I\St 7 4d~Rd+ ~ /r V 26~U ~ a ~1 1 1 ACCIOENT. ~tCWE p pATE OF IN,R161Y (Ab.. p~y. Yr.) MOl7R OF IWUNY OiSCitlBt 1ipW IMlt~IY pCCVRRED 274 M04AC~6E.orUMOETE/i!/~MEOlSpulr/ 33 For~ 61t, ?~a x~o ~~c u tia WJV11Y AT YNpHK /SpKrh PIACE Oi WJl1RY-M Norn~. I~rrn, ~bs~1_ IKfOry. W1K~ IOCATION Sii~ET 01111 f 0 NO C~TY OA 7py~y giATE ~ Ysl Pr N0~ a.aw~. ~ rsv+ury~ 171 11 - 7 t f~ f'! 7f~ • ~ ' .TF ~~~RI[~a~~. i h~re~y osrtity thte to De a tr~ and~~wrect copy ot tha ~oce~ ~ R~Iitirart reoordrCai~fib in ths St. Luci~ County Health pepa~t• ~o n r~ P~;= ~o.w.. 'g6 i~V 19 P 3:29 t - ; V ~IMarnir~ tdq~ vslid unl~s ro1~c! seal of rhe S~. l~,u~ ~ ,~iq~t~~/ ~i~h Otpsrtm~ttt Is affixsd.) ~ FILED .ti!;1~ ~ ~ , ROGER f~u~ I;~,;:~. ~ ,.E Rt; MiUfR, 1~l. 0. ST. Lt1Cit C;:~NI Y. il. ~ 'r ~ ~ 1 k~hh, tocil R ~Rr ~ ~ ~ • J ~ ~ C~ 5 2 l E;,c~. n 9 5 7 ~ ~ ~