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HomeMy WebLinkAbout0925 ' i ~ i . . , t , . . . ~ . ,J ' ~ t . ' ~ . ~ ' On iAw7 ` r C~RTtFICATE C5F DEA?H - - ?EIIYAMEMT ~ aucx w,c ~~~E ~ ~ L O R 1 D A ~ SEE WWpep,pK OECEOENT NAME i1RSi MiODIE LAi+~ h[ c pAIE U~ UEAI~I~Aro L~a, w" Novella Heck Clemenzi :Female ~ A wg,~~~s , g~st_~,~98b-- 66O RACE t9. WM!t B7iC4 AGE' lat~8~rinday UNOER i YEAN U+lGER e(?.i. pq1F Of A7RIHi41o s. ~ CLUViv c,i GF~L~ 7a ` A,n inaun etc ~Svec,ry~ ~ris ~ -T-'- ~ Sa Sb ~ DAYS ~OURS ~ r.~i•~S ~ ~~n~ _ 1. C+s_.L~ ~ ~ ~ v Z .1'=.7~~ Gl1Y. T~NM OR LOCA710N Oi CEATH MOSP~UI ON OIHER iNi'~i UTIQN N.~r~er+r ~iU e.•ne~ q~:r ~~,ret.n~1 „~:~.c.~, ~ U~~rySP QR iqST Unq~~ at> pOA ~ OPf r Hm Inpit.pni/ pe~,ly; F ' d Reoional M 'GdL~Enter mfnPatien~ 7~ STATF OF BIRTIIIllno7 m CITIZEN Oi YVHAT COUNTHY MARqiED ~~E'rEp ~RhiFn SURV.V~!iG b.Pp:~SE ~~'+:le 9~.r i. r.,,^.. _ USA nim~coun!ry~ WID01'#D CivC~CED~iJw~~-~i,~ • e 9 ~o " _E~IIIU ~-I.L'IAEIIZ.1-- - $OCUI SECUH~iY Ni1MBER USWL OCCUPATION iG .e •~^10/ wo~~ .nr ~..~.ny K~ND qi A~,;`:i!tiF (~R iNCuSTNt~ ~^~s•: r.o•~~~,, r!e ...r~ d rEr„en 'L61-09- » ~~n~~ NESiDENCE~-$iATE COUNTV CIiY,TpWNOHIOCAT:c.V ;TFEEtAtiDrtUkO£H INCICECITV.IIAIT$ ~4 ~SK~~h ~esD~NOi Na ~ 11b ~ t~t ;a.y ~~~n~ uin{~~.~a tse n j-d-~a J-yiaRU- ~AiMER- NAME ~Iq$7 MIpbLE LAST ~.~7'~~[H - l1A~GENN4I.~E i1H5T tihODIE 1A5~ ~ 15 iE • ~NiORM~NT -fUMEr Irp~ or Pr,nr~ MAiUNG wODRESS ~1ctEE T[7R R i D'v'~ ~ , MLSS 1 Ck CiTrp: G\YN STA~E Z~~' t)a ~ f74 ~ 7AG7 3+w1- ' BUFiA~ CqEMAT1pN,RE/,AQVAI.OTHERfSPKJ~! CEMETERYORCREI.IATOAr-~.a1/F 'l ~~TiC~.t C~'v(;RT01.N STaiE - Entombment ' ~ • ~Ul1ERAtDt T --~S~gnalwl ' 'J'~ ~ FUHERALHOME Af'~DAES`-. I , ; I iW ~ ' ' . ~ ~ t9D ~p"'?T^ s.j(llllp ~~X-- ' j = XH 70 fAt DtSf my t~Aw~Wqp. dl.~!D unlO Jt~fA! L+ne. Cit?~a^0 D~~• , 'ue i • ~,f ~ nai~s .,~.af-: , d^i ~n.rz!~ r.~. , ~ t ' qr.t r ~ o~.,^ ~ n~a' :.cc.~•e~ a~ frc ~V eo ~aso Is~ ~u~ea L t us~ . ~ .~..•e ,-.a ~ _ ,^a e..r t, ~oe ca~'ce,•, sr3t~.f 1 9 j•' o i 15~9n11urp ~d T~~If) ~ n ! ` 7 i (s~~~ anO 7+1M) ~ _ . ~ ~ Dai S~G1~ O~MO.O~ Y~ _ ~ I ~ , E X r. H- a~ ;;nrF~.:r,~.:F MC>unpcCrar.~ O . ~ • 7/.~•.. ' r I f W . t ?iD ~ tL' ZOC 1• ? /7 ~ V < 4~ U ~ E` NaNE GL AtTENO1NG PHYSICUN IF OTHER TNAN CERiIiIER rl~po v ~ Ep .-.~E,.. "i ~C . P:!,';4:;'.•.C.c;~';EFp • c.~ . 0 ?~YJ i ; M ! ~ r v ~ ~ _ II~ME AYDADOAESS OF CeRTIFlER IPMY5IGIAN MECICA~ EkAM1NEN~ . ; 2~ Ro elio Mi. Gonzaiez-Pe , MQ 2215 Nebraska Ave., Ft. Pierce, FL 33450 . REfi~S7RAR •,~4'F FECF~~.Fi`9<<~i ; STqaP it. pr~ 73, ,~,:,.~w.,~ . ~ ` A ~ l , ~ _ , ~ ~ August 26, 1986 - . l _ - iM1fED~AT£CAUSE jEN1FRONlYONECAFJSEPEHL! FpA~~, ~h: " ` (:-;rr.~~tv!•een~,~~ss~•e~~)~~a•r ±!;"t Metastatic advanced carcinc~ma of CG~GII. ' - ~ _ ~ CUE TO OH AS A CON OUEHCE Of (COnd4pr~(s) whiC~ p~vp r~se to ed.v ~a; L~SC ..^Ji =~:v_ .i r, I:~~er. c. ..•,s•.~ 6en+n Renal fai~Lre ~ _ GUE TO. OR AS A CONSEOUENCE OF ~ s;., a~„ ~,a:~ 21 ~ i'. rc~ ~ .~~~~~L~ilib~~ ~ ~1 ~al' ~ OIRt W ~ :n a o ion a§tro t~t~i', s . ~ . ~ _ •"3,. ~ - . ~ _ ::~~~~'.:.~_-i. ~s : ' ~,r. rv,oeawi~ ~eaoeNr su~croe o. D~rE OF i?+~uav p+o. Dar. r~ ~ ,N;: a, r._ . r.:~. <.uaueo , 27~ HOM~CtpE o.uNpETERM~NEDISp~cd~! J . ~7. z~o - j`~ _ ; RS FWT S~Y. !NlURYATyyQRi((SpKdY VLACEOF 4NJURY-AtqOm.e.fum street lact~•r c.^,'.F• c'.:::5i LC ~A Tp',tiy STATE ! N 84 (ObiolNf6 r~s cv nro~ ou~a~•g eu ~SC~a~~ , ~ - ~ ~'rV10lJS ~di[10M ~ ~O~ ~2~~~ 71~ 271 . ; ' . ~ , nrreuy ceri~ty thr = . . . -:c: , ~.;;,j... 8~~~ Reqis;r~~,~ ~~,,.o.~ r: - : • _ 1' me~~ For: p e • , : ~ ~.3 : ?ne :~t. Luue , ,1AN 19 q~p ~y~ (Waming: P~e! ~ ~ .7U Counly.,:'rle :h' VC1r V-rf~~ .~s ~~~;x~d.) " \ j~r FlLED l,h.: : " N. D. M.!~~~~, ~t. D. $Y ~ , , ' . Co~unt~l .fia~:itt Otf~c~i~, ~ l.acal Reqis+rai L~C~E t,l.~:'i \ . 7 ~ i ...r .r . (o '~~O ~ ~ " .CC ~t~ ~ _ ~ c,~-c.t..-: v ~ ;~l _ , - o.» p•s~„ •b~~ ~~E~MM .•r., : ~~528 Al~0922 ~