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;~'tHtiS CERTIFICATE OF DEATH p 48,546 ~
°~`"'•"E"' 7 F L O R I D A 8~~7~~
~K tOt~l flLE NO ~
~E OECEUENT-nIAME FIR51 M~DDtE IAST ~
~.v,;,,gpCrc • SEz O~IE OF DEA7H~uo D~r. vr ~
iOp Annie Jessie Brown Cobb 1985
.:s~~*~+s , 3 F'emale ,October 29, _ !
RACE-ey. Wrret &x~ AGf-las! B~rtnoa~ U~JOER ~ vEAH UNDER t OAY DAiE O~ B~RTHiMO. Da~ Y~ ~ COUNTYO~ QEA1H ~
~~r Z~ ~n+ ~na.an etc ISOeuh~ fyrs r,,~05-T_ '
. White S, 9i ~ S~ i G~rS ~ouas , MINS 6 Au ust 1~ 1894 Brevard
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CITY.IOWNORIOCATIONOFDEATH HOS~'~TALOH07NERINSTIiUT1ON-Nam!lllnpt~n~•~np p.~fn~~UrVnu.r,p~ry 1FHOSP ORINST pna~~n~ppx ,
7b OP.fmlr Rm.InpatrMlS{vcd~~ {
. „ Cocoa Beach Ca e Canaveral Hos ital „ DOA
STATEOFBIRiMllf~qt~n G171ZENO~M'NATCOUNTP\ MARRiEDNEV~RMAqq1ED SURVIYtNGSPOUSEIIfrA~qn~mi4Mnam~~
7A _ USA.ra~crr~.n+ryi fV.7~xE~ t1t..^,RCEDiS.et~h'i . ~
. ~ Florida , U. S. A. ,o Widowed „ None i
SOCIALSECURITYNUf~1BEi1 US:IAIOCCUPAiIONIG+q~.ntlOl~e~lCOnlOurry K1NpO~BU51NE550RINDVSiRV 1
a- mos~ot.ai.npc~c ~.en.~.~r„~a~ i
266-24-5??9 Homemaker Domestic
AES~DEMCE-STwiE COUNTV C~TV. TOwN OR tOC~T~ON ~ STREEt AaD t+UUBER - ~NSiOE C~Tr u4it5 !
lSpsuh ru a Na !
,.,Florida ,.o St. Lucie ,K Ft. Pierce ,.a 3616 Okeechobee Road ,..No `i
fAtHER-NAME FIRST MIUU~E IAST M01NER-RAAtpENNAME ~ FIRST 4~~JDLE ~A$T t
~ ,5 Robert Lee Brown ,6 Annie Hogg
ItifpRMANT-NANE(7ypeO~or~nr~ MAI~INGApppE55 SiREl~ORRiONO ClirOpTOWH STATE ZIO
,,,Jeanette Willis ~,812 Boston Avenue Ft. Pierce, F'lorida 33450 i
r BURtA~.GREMATION RFMOVAL.OTMERI50!c~ry; ~CEMETEHYORCREMA7pRY-NAME LOCATiQi CITYORiOVYN SIATE
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,,,Burial Ft. Pierce Cemeter Ft. Pierce, Florida
. ?~~R~~o~ ~TO s.~~,~~ #i~g fUNERALHOMf gazrd Funeral Home ADDRE55 ~
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' ~ ~ „ 901 N. 7th Street Ft. Pierce, Florida 33450 !
~ ~ ?Oa To tne Dest d my rno e cu e• n urne. Cate na ~ anG aue 2ta On Int bavs ol e,am~n~don a~0'or m,estgat.on. .n my op.mon Oea~n occunea a: tnc !
. . aV to tRe cavselsl S[atlC ~ W lune. tla!e ~nd D4C! ~n0 Oue b Inc Ca~sels) italed
Oe (Slgnatwe u~0 T11k) ~ ' / ~ ~ ~ (Sipnstu~e an0 TNfe) ~ ~
-
~ !~O OaiE SiGNEDf~o. Dar~ r~ l NOU~i OF DEA . n~ DA7E $~GNED rM0 Dar Yi ~ MpUR Of DEATH :
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a= ~ 10/31/85 ~ 10:40 A.~ S~ „o z,~ M
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- E~ NAME OF ATTENDING PMYSICUN IF OT~tER TH~1N CERTIi~ER 17~pe p Gnnry EO FRONOUNCED DEAQ r?Ip Di Yr ~ PNQNOUNCED~EAD(Hpurl
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~ V ~ _ - --.J_-__ --710 CN 7ie AT _ __-!J~ .
N..MEANOADURf_LSOFCfRTtiftRi~HV5~Ct44 VEC•Ga: E+AM:NCR;~irppurp.~r.~~
,z ~5lilliam R. Addingto*~, M.D., 465Minuteman Csw~., Cocoa Beach, Florida 32931
~ FEG~STRAR ~OATE QEC[~vEDBvqEGi57RAF~MO pa~, y,~
?3a ~S,qna',.~ei ? ~C ~~-r.t~_~_ _ ~~ICG~[:~lEtL~ t~~~'~1l~ - ---~?3°_~.~5l2c1~~1~~`~~
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R'r.tEO~/+TE AUSE ~fNiERONL~OYf C4t~Sf CFFtUV[ ~ORrai IDi RhLrci j I~n~en~iLerweer~u~xtaMA~atn
iART (e~ ~ minutes
. ~ Resgi rat_o~ __arrest _
y DUf 10 OA AS A CONSEOUENCE O~ (Ca
~~C'.a~(s) w-~.:.1: r:se to ca.,s~e (a; - l3t ~•,.;er~;,ng ca~~se iav) ~+r.ie~.a~~ Ge:wre~ 4nsr: anA oEa!~
_ ~oa Cerebral arterioscl_erosis ~ years
OUE TO. OR ~S A CONSFOVENCE OF ~ in~e..Y Oet.een onset anC Qeatn
- 24 _ ~ , ~
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• PAi1T OT•,rR Sr~':.i~~~,r CCr.!yT.^J'+S- Go•a~c-s c~-r,w w xa.r A.' ~n .t:a•ee'c cr~tc q.e~ r. PMt ~ ly FAAT W ff FE4alE N'1: TnERE A ~UtOoSr CJISE R£~E WzED i0 vE[K.AL I
Z7} • ~ves
L~ N i/K P45T 3 FIJr.T~6~ t.rs a~a~ E YwWER fS:eeN r~s a ro7 '
- - 3C n NO ~ NO `
~~+cCaDry1 ~CC+OENT Sv~GDE o~ DATE OF R.1UHY (MO . D2y. Y~ ) HGUR O~ IN3UHV DESCRiBE NOW IMJURY OCCURREO
27~ _ nG'a~CtDE. a IwGE 1ERVipEO!St~eu/~)
~1RS Form 512, ?~o _ ~tc _ M ~ia
~ INJUAY Ai WOFtK fSpecdy PUCE ~J~ iNJURY-At nomt larm St.ee!. t~ctory. O~~~tt IOCAT1pN STREEi OR q F O NO CITY Oq TOV?N STATE
M':rl 84 (~b501B18S res or Nw aa~o.ng eic lSMCd~~
i 9YioU5 BdiliOnE T)e 77t ?7g '
~~.s oi 12-31-84 -
: I Ht~t};BY C~;K7'IF'Y 'l~~E ABOVE ~ BREVARD ~OUNI'Y~ALTti DEPAK'I'1Tg~TI'. CORD ON FILE IN THE.
- U~CAL REGI S17ZAR' S OFFICE' .IN
(1~ot valid iinless the~,Seal of the BxLV~~d Cotiinty I?~a1th D,~3r'~r?~nt is affixed. )
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N0'~`l:w ~9~` . .
- . ~ ~gZ SEP 22 P 3 ~26 Q'~~ ,~f~
------1~ate ~ Sea1~~-- , b ~ Chief Deputy Reglstrar i
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ST. LUCIE `'i • U R'~~ F„GE 9~~ "
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