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HomeMy WebLinkAbout0992 r • • • ~ ~ , - - - - -------~_._---------------------•---_~.~----------------------t--- OFFICE of VITAL STATISTICS ST 49,296 ~ ~ ~36~$~:~~ i ~ ~:~i~ ~oA~~,~ of tlculth CERTIFI~CATE OF DEATH s~p<< N°. ~ , Bureuu of Yita! Sts~tislics FLORIDA Hegistrar'a Na 1 --1. )'1.ACF: UF D~ATf ~ U8UAG RF9IDl~T~ OF U£CEASf:U: ~ i (s) C•.v,~ty . .t • lliatrlee No. ~3 • ~ / ~~.jj!~Jp- - ~ Ibl 1'nctnct Prrrinct No. 'a i~) 64te ~ Ib) CnunV_~`-~ r ( WfitC RIIrtiC. Rvt pU[hI~lt) ' ! ; Ic! Citv or Cier or { T.,«:~ _ Town Na (e) CitT as lown ~ . ~l[ ocl.(Jn ci:y ur tc„ ~ lirni~ write R ~~t ho+yt~sl or institutian _ Uf nut in ~cnpit~l ur `~titutMn, wrSteareel unmGrr or tocatiun) (d~ g~n,+~ ,aJo_ ~~t!~- - I lel t r.~¢tA uf ete7: Ja kosi~itai or ~tituei.,n lit ral. gfve loc'ativnl ~ r ~~.rr.•nunrtJ A ; ~ ~r • In ..u ~ ~ - - ~Stxcits N ctl.a f.•~ra. mcnths cr dns~) _ < <r) 11 for.uga Lv~n. 1:~.,.~ lon~_in `L'. 4._ A - _ _4- }tvs ,i_ - - -_r_ _ - l~ ~ . II'='1,('I.L 1Ab1l~: (~F DEC::ASED ~ ~ '-_~253~t~~a~~ ~_~__I~lfl-~.~-- !f ir!.•:ao. 3l~1 :el ceeutit9 ~ - MFt~tfAL~ yfB3~'ir A7ION 1, ~s . ° D ~ I _ _ _k_ _ ~ k: ua:rr:v.yr L..:'.._•'-----------~~ :rr ~ - ~ 20. Patr o[ 1)etl2~: ~.r.:« . - , -~:.T . -7.- p ` / is~. ' s . _ • ~ ~ Ylsr ~ _ h.,,:r ~ Alinote ~ ]t. i: 1. Scx • :~cS-!'""_"'.•'. C~~i~'•S~!?arn _'._f_",.~-'___ . . _i. 1 ACt t i7Y ti~~: 1 Atlcr~.['i3~ th~ u_n:Z.~-J ~r..r.~ ~I 6. 5~1:. rnarri~d. u•i~!ot.rl ur ~iivorced :1 !(~~:-~.C.~'-„----- j~~ _a~~~~'----- 19 :SZ_T~ 19~,i ~ 6 ~a? 1( u~ar~i.~d. e•iduntv3 or ay.orc~d.~~ ]huat+~ .d of Ivt) - If'--- ~ :_~~t~ ! , ~ ~ t6at 1 last s;~r L.~YLZa1ic. oo 1~~y~t . . . : .-~:Cc n[ _ ~_:.~.L_i~~»__. r-'^ r - '}i acd tlut dtatb ocCSrrrd on th: date rn~i hu~r statnl ~bu~c. j D4iat(op , ~ t..~ o.` }.:t,l:,~,.i .,r a~i:e. ali~~C-'----~~ i___ ~ Nats~I Iro re-e c[ dcc'ti j~-- ~ nTMi~ _ . - , ~ ~j i. l:irt~~ ~1a:: ~f II:MJYEII ~ . ~Y"y-.J~ia_~i ~ _ ~`/i,~ I: ! I ' i _____..~r/~LL~~.~__~~ - - /I+nuntA/ lds~1 T;ea~ r) ~ F t+ .~~:r: lean Siontbs ' Dpi ~ It leas than one da~ Qne to ~t t ' j-, , ~ ~ - ' - I ~r ----~y ~ ~ hn_ tn:o. Du: to , ~ - - . ~ ~ > . . 1' ~ . S:irtht.tact ~ _w t . _ •~71..:1,- , ICitY.10M~not tJ,• (SLteoricr~~~:e~cou~:i71~, ~ttktr e~inditions :clc~ ; r~sn~ncp n ErF.in 3 r,:.ntF.s of death) i I 30. Uiuaf uccup~ttan _ ' _ !__y`---~ ^ ~ il. In~',qt-y or uusineu -,~,-1„~ Mnjor 6edinp: ' of opvtstiotn ~V~~!!1 I ~ i~~ 1:. t<cmc _~~--_,~I~~j,~_ h ` i ~ ~ . , T ~rtht~ta•e _ ~ ~ ~Gsce datc r,t eparaliun) ( ~ r 11~b• ~ - o( •utoyaY _ c6srted da • ~f.~ + : _ ss.:~:::, o,~~P~ .~,ry - ii i~bikan~. ~ ~ ~ I5. 'tiribaiace ~ - 2E_ If death w~as dur u+ exutaal can.-~a. .^:i: ia thc f.-.llcvinQ: ~ { Ib. l:.i~~:n~aut'a Si~cnature~ Acci~ieat, .oiride. bx-:ci.2r (~yeci:r} _ ~ ~ i ~ 25 (si A.!3:=-sa ~°.~!S._- • l1~~ ~ Ib. D~le of rtarreoce - ~ ' (e1 ~5'6ere ~F:J ix;;~:ry rcar? ~1 1?. bnzial, creinrtiun vr rcmnca! . • :j f'' ~ ~ ..:.,+.y~ IStat~) ) j~-. ~ - Idl Uid i~iury occu~ =n x r.3:w. A,.n:-. f~.n... ~,.~;~.u~ui PIscO, is ' li Uate / ~ _ _~~_.3_ l7 (a) P~ ib. b'uner~l Direetx-~'s" S[{{[fa•ara - ~ Puc:ic P~ar t - - - _ L~~.Ir~`S,i~~~ f- tiSDec:IY:..~eufYin[•:) ' !d (~1 R3drux ;~dd•,,,,~,~t - - - VL'hl!c a! v,o _ tl . in; - ` 19. !'ll.r~ ---~6 f 10~~ - - - :3. Si=natuz~ - _ U ~ („ve~ilteTaVar f{ ~al A~ilress -.4 . . __-~li. __n,3 L • ~ j ~ M . - i . , 3~}R!'~~~ FA,i e7i7~ CERTIFIEO COPY . ~ ' ,1 : r „ ~,t,:-. 86~2.~Jr THIS IS A CERTtF1E0 TRUE AND COARECT COPY OF 7HE QFFICjAL a£CORO S7N-fICE'fN THI~Q~F~CE ~ ~ ~2,30 C 18 ~ OftHfS . / - o,~ , gY- ` GC~/ oL~v~a~r~. eooAOE - y~t. ~ ~~~5tate Registra~ N., ~ . ~ _ g ~qt~ce otvitai et4t~UGLJ~~(- l4 . u ~6 ~ ANT REPHpp(y~,T10!i Of T{AS OOCUMfNT 1$ Pfi6M91TEO BY L/+iN.'~'•{ipT, • sr LUL'ic y ' ~ AGGE , . y. , WARNlNG. ~'T UHLESS OH SEGURITY VA~cR WIiH E4~dS5E0 t3AEAT $Ell~ pf tf~ SiATE Of iLrRIDA. ALTERwTlO#J OR ERA5UHE V010S iMi3 CERTIFICATtOH. ~ ~ mL~ ~ °~owe~"` . _ ~ . ~ ~ • ~ ~ ~ HRS Foim 156•/ !LE7} ~r ~ - - ~ ~