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~ CERTIFICATE OR DEATH . ~ $~,Q~', ~ ~
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~ DEGEOENT-NAME FIRST MIDDiE LAST SEX OATEOF DEATNIYo.O~y. Yi.?
FIAMD/OOK •
, CARyI, , Mala , May 27, 1986 ;
~
A~+o E-~ 9 Nyc ISp~uyl A~_~ YnB~~Y U~p t vEAR UND£q 1 pA~ OATE OF 9111TMlYa. Dar. Yr.l GOl1NTY OF OEATH .
.~te S, b~ ~ o~rs ~ uas , ~uu+s 6 July 21 ~ 1917 St . LuCi€
~ C~TY, TOWM OR LOCATION Of OEATH HOSPITAL OR OTHER INSTITUTION-W~M/lf npt m I:IAM. OM NrNf MW n+rwOKl iF HOSV. Op ~NST (teW~ca~~ DOA :
OP~E r Hm.lnp wntlSp~tdyl
„ Fort Pierce Lavnwood Regional Nadical Ceater „~npat~ent
STATEOF9~RTMl~~~d~n C~t~ZENOFWHATCOUNTRY MARRIEO.tiEVERMARHIED. Sl1AVIV~N(3SPOUSE(llrrJRpM~nW~nnMrN~ •
7d A na tounl~yl WI OYVEO D1V RCEO ~.~Spsa7YJ
, ~I~ch~gan , U.S.A. ,~arrie~ ,,.Ella Nay Korris
SOCUL SECURiTY kUMBER USUAL OCCUPATION ((3M ~M00~ ~WR dpM dunll~ K~ND OF BUS~t~SS OR 1!laUSTqY ~
t ~ror~up l,!s. / ntuWl
12 369-09-8916 Retired L~~t Truc c~Driver Muller Brass Company
RESIDENCE-STATE COUNTV CITY, TUWH OR LOCATIOH STpEET ANO HUYdER ~NSIOE CITY 1141TS
1, (SP~d Yp O~ NOI
Florida St. Lucie ,kFort Pierce ,.,1103 West Joy Lane ,N l~o
FATHER-NAME fIRST MiDO~E IAST MOTHER-MAIOENNAME i1RST 4iDOlE UST
,S Hamilton L. Caryl ,6 Lois Maud Rockwood
INiOfiMANT-NAME 1 TrpeW W~ni~ MAILING ADDRESS STHEET OR R F D NO CITY Ofi TOWN STATE ZIP
,,,Ella May Caryl 1103 West Joy Lane Fort Pierce, Florida 33451
6URIAL CRE AEMOVAL.OTHERrSOSC~fyl CEMETERY Op CREMATOAY-NMAE LOCATIOFI CITY Op TOwN STATE
,~,Cr o ~is ey-Hobbs Crematorium Fort Pierce, Florida
F~~~ o~ cT s~~.~ ~ FUNEML HOME ~~E~ 3015 Okeechobee Road ~
19a Naisle -Hobbs Funeral Home Ft.Pierce F1a.33450
a 20a To ~nx Dast my t + dcatn oc urr e ~~R+e aa~e a.+o Wce ana oue 2ta Oi1 thQ Dif+f O~ l~~n1~MtM~1 ~nNOt Ifriyt~ltpn. N Ty OQ~IMOt1 0t11n OCCWfW ~I lh!
~ ~o tne cwscl su~etl a~ ome. oaN? an0 D~ anO Ous to tM u~ls) wtsC
. ~ (67~W~x~ ~M TIIM) ~ 1 ~ ~ (f+M~+M and riN) ~
z~, DATE SiGNEDlMO. Oar. Y~ i R OF DEATM . x DATE S~GNEO /MO. Day. 1 HOUR OF OEAiH
a •
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~ =y~ 20b 1 ~ Nk Z~ S P M V tiD ?it M
0~ NAME Of AiTENDING ~N~StC~AN IF OTNEp THAN CERTI~iER ilyps o~ EO P~ONOUNCEO DEAD IMp. Ol~. Yil PROHOVNCEDDEADlHpur)
Nt!~
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NAMEANOAODRESSOFCERTIFIERIPMVSICUN MEOICAIExAMfNEpl/TypaOrpnnll
22
j pEG~STfiAH ' ` D~iE pECE~vED Br REG~Siw~p~uo. Oay. r. ~
i ~~„5~~,~w.,? ~ S ZF3-~3b ~Y 28, 1986
~ 2~ IMAAEDUTE CAUSE ~£NTfA ONLY ONE CAUSE oER tME fpR /il ~D). ANDltI I ~~ntensl Oetween onsN anA aeath
-ty~ I
` i rMT i.i t~ ~l \ cJ v~r~0 r ~ S 1
DUE TO OR AS A CONSEOUE E Of (Cor~+(s) pave nse t0 cause (a) - Lat untlerirnq Ceuse las[) ~n~ena~ De[,~ecn onxt and Oestn
r `1 ` 1 ~
? o ~Gr ~~~ive ~Qon~ \li t
~ . DUE TO OR AS A CON OUENCE Of I Intenat pe!reen onsat uM deatn
6 ~ . I
? 24 ~~`cv ~i't- Li v ~ t. i C c,
~ ~AM OTN'_R 51G"tiF1UNT GOMpiKXi$-CMO'Crs Cv[~Qrp q O~a1~ ~,t ~+a re~zM'o Carse yys+ n VMt 1(q ¦ 6 fE1/ALE. WAS ~HERE A ~UTpp$Y pEiERREO TO ~IEPCJ4
¦ GNAN(.~! N T11F ~~15T 3 MONTN$'~ (m a~ EIUVMER (SOeC'N M~ a rol
2T~ ra C No ? ?5 26
(Crop~Oyt ACCiDENT. SU~C~DE or OATE Of ~NJUfi~' (wb . Da~. Yt.) NO!!R OF ~1tlUHY ~ESCRtBE HOW INJi/RY OCCURRED
27, HOMICIDE. a UNDETERMiNEOiSpuyl
27a t76 27[ M 27A
FOf1Tf S1Z, 1NJVRV lt1 WORK (Sp~uly VLACE O~ INJURV-RI nan~. larm. ah~et. lactory. dtK~ LOCATION STREET OA R f O HO CITV Oq TOWN STATE
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