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~T t CERTIFICATE OF DEATH B~~~S9 C/f
FLORIDA J
~ IOCAI fllE
~ OECEOENT-HAIJE i1RST M~DDIE IAST $EX OATE OF OEATM(Yo. O~Y. Y~.1
NNIO~OOK
~ ~ ALVIN WAGNER DREYER :Male a June 26 1986
.urm,c~ioae ,
HACE-a g. WtwM. &xt AGE-Las18~nAday UNOfR 1 ~EAR UNDER 1 DAV OATE OF BIRTHfMa• U+K y~ 1 COUNTYOf OEATH
6602 ac isqc~yi m. w~ , o~rs Houas ~ MINS
i . White 8~ x aJanua 19,1905 St. Lucie
~ CITV, TONM OR IOCATION OF OEATM HOSPITAL OR OTMEH INSTITUTtON-Werr(If nol ~n MtAN. Qir~ iln~1 antl rwmD«I If NOSP. OR INST. ~1rWrcit~ Dp/1,
~ ~ OP/Emq fLn., MpatrnllSp~t/Y/
? „ Fort Pierce Sunrise Manor „ Inpatient
~ STATE Oi 81RTN~IInol.n GTIZEN OF WMAT COUHTRY WARR~ED. NEVER MARRIEO. SUAYIVING SPOUSE1~f r~N. p~w~naM~n nyn~1
~ 7~ U.SA.n~en~carury) 1M~DOWED.D~VORCEOISpcdr/
! ! 9 f0 »
t SOCIAISECURITYHUMBEH ~ USUAIOCCUPATIONldn+~+~olwo~t~lonl0w~ny KINpOFBUS~NES3OflINOUSTRY
mpst N ral;rg fd~. ~r~n J nG~WI
17a 1~p.
PESIOENCE-STATE COUNTtl C~TY. TOWN pq ~QCATION STREET ANO NUYBER ~N51DE GTtl ll?tIT3
. Apt.201 rsv~c.yr„awo~
y ,a ,<b ~k ,.a Yes
~ T. ~ fATHER-NAME FIRST IJIDDLE I.AST YOTNER-MAIQENtiAAtE FIRST M~DOIE U13T
a
=M ~s Isaac Dre er ~6 Harriet Mills
~ INFORMANT-NAAIE fTyp~ or ~r.ntl ~MA~LING ADORESS STREET OR R F.O. NO CITY OR TOWN STATE ZIp
~ Zoa Dre er »01351 Ba shore Drive A t.~201 Fort Fierce Fla.
a BURU~. CAEw?i~ON, REMOVA~. 07HEAtSpea~y~ , CEMETERr Oq GpEUATORr-wIME IOCATIQi GTY OR TOWN SGTE
; 1i~
: ~e, tion ,i~aisle -Hobbs Crematorium ~x Fort Pierce Florida
~ Fur~ru~ oi cr ~,rw iUNERAt H0~1E AODiE~ 3015 Okeechobee Rosd
~ ~ ~ ,~o Haisle -Hobbs Funeral Home
~ ZOa To tM bes~ d . Osa n urn0 at h e ana Cue 21~ On trf! W3~s of essm~naGOn anNOr ~meit~yatqn, in my op~nepn p~aM Ottwrb it UM
~ to[ntuw~(s?s ted. ~ ~W t~me. dat~ ~nd Dyu ro Me caufe(sl sllted
' ~ ~ (SIOnM~~ rW TNM) ~ ~ ~ = (al~e~ihue Y~d TNN) ~
o OATE S~GNEOl~uO_ r. Yc) HWR OF OEATH DATE SIGNEO lA~O. DIy. Yc1 MOUR OF DEATH
C ~
S L Zpp p~ • M V< ZtD Z~c M
~ NJIME Oi ATTEh'DING MYSICIAM IF OTHER THAN CEATIFIER IT~pe o~ Piinll Ep PHONOUNCED UEAD IMo. Day. Yr ~ GROrtOUNCEOOEADlNOUr/
ta1Y
~
~ U ~ 21a ON Zts As F1
~i NAME ANO ADDRESS OF CERTIFlEH IPNVSICUN. MEQfCAL EXAMINER~ ~ iypt or pnnq
~a . ~z D Fo Pierce Florida
~ REG~57qAR ~ ti ,f / , DATE aECErvEDB~ REG~STqAAtiMo_ O~y. Yi ~
' p - Ju~e 30,
i r~. ,s~~„~.., ? ~ ' /.~'l1f' ~%i . ~ --6- ~P " ~fc: z~o 1986
~ ~ 2~ IMMEO~ATECX-1)SE (fN1ERONlYONECAUSfPEHIINfFORI+I.ID).ANDIt/.~ ~~~MUVaibN'~'Mnonsata~WWrtn
~Mi la) ~3 ~
1 C
~ ~ DuE TO. OR AS A CONSEOUENC OF S) rnc~h pave r~se lo ceuse (a) - l.ist Intcnal benrem onset s~+0 MatA
~ D ~G--~ _ _ C ~ ^v oau~e ~
DUE TO. AS A CONSEOUENCE OF I Inteni~ anet an0 d~atn
24 ~
c
~MT OTMEA SrY1f~CA,yi CQr~pT10HS-COn6torls OOrtnW!:ng ~ AN1~ P/ naf re+=e0 b Ca+Y qvM PAR! 1(y ?A1tT ~1 6 fE4A1E. Wll^f iNERE A AUTOCSv GISE REFEfi7~D TO MEOICAL
27f ~ PfiEYGw~"iC~' WoTr# P~.ST J ~YONT~6'~ ~yK or ro/ E~UMWER (SOeah ~es a ro)
n NO ~ Ye8
~ProNDry? ACC~DEN~. SUICIOE o~ DATE OF INJURY (MO.. Dey. Y~ ) HOUR OF IW URV OESCRIBE HOW INJURY OCCURREO
Z'4 NOMiCi~E. a UNDETERMINED1Spuy1
HR3 Form 512. 2~a z~e z~c M 2~u
INJURY AT WOqKlSp~tdy VIACE OF INJVRY-At horr•!. lum. street. lsttory. dLte IOCATION $TREET Ofi R F O NO CITY QR TOWN STATE
Jul 84 (Obtoistas rn o. xo~ anw~~+q e~c rso.un~
P~ vi n
as a t23,.e4
8~1~.(J59
-8 ~?2 :?8
<~r ~
i tfik to bs e trus ~oPY ~ th~ i.ocai
~ neroby certfY V County H~altfi D~part• ci~
ReQistrars record on file In ,
ment rt Fort Pierce, Florida~~
~~ira~s?d s~L of the St. Lucis S _ ; ~ ~
(Warnin~: Notrib ~~'-~S ~ffixedJ
Cou~siy : L'h~~cpartr~
~ _
`i;:'' , .
N. D. MIttER,'M. D.
ty• Health C)ff?c ~ ldce~ Re9istrer
,
~l~ ~l~ .
oa+r o.puty. lo'te~' Rec~t~,:
~ ~fl~27 t~0~~1
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