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OFFICE of dITAL STATISTICS
,
~ CERTIFICATE OF DEATH
LOCALFlLENO. FLOR~DA
~ OECEOENT-NAME FIRST GkppLE IAST SEX OATE OF OEATH ~Alo. Day Yr~
~ kOBERT EDWARD ~AWSON ? MALE 3 UCTOBER U~, 1987
RACE--e. . NRtde. &xk A(iE~-last B~A _ UNDER 1 YEM UNQER 1 DAY__ OATE OF 81RTH (mo. Day. Yc) CWN1Y OP DEATH
~o:~_i~r~ r•s? ~ Mos OAYS ?+ouas ~+iNS ~ANUARY ~4~ I925 ~ROWARD
Sa. 5D. Sc. 8. ~a
C1TY, iOWN OR LOCATiON OF DEATH HOSP~TAL OR OTHER INSTITUTION Nams (d nof N~iEher. 9ivs ~n+N snd n~mDN) IF HOSP Ofi WST~indcate DOA
~D LAUDERH Ill. g3a~ ~f/, ~i(~, ,S'/ ~'T-R•~~,c~- '~~^'~r. Rm Inpat~enYSF~JYJ
STATE OF BKi7N~~~ !n-`ot in CITIZEN OF 1KtiAT COUNTRV MARRIEO, NEVER MARRIEO. SURV~VIlK1 SPOt)SE (N wXe. y+w maVan narr.el
e"S'` "~~I_'19°'"Y'~IRK 9 ~•$•A• ~o DORIS ~RI E DIGASSO
SOCIAL SECUR(TY NUMBER USUAL OCCUPATKIN (CiNe ki+d ol wak daie drinp KIND OF BUSiMESS OR INOUSTRY WAS DECEOENT EVER ~N
i2 115--18-7099 Too~"'°°~ °'D't~"° Y"~°°' I~ANUFACTURE s 1 SERV~~Es
rt~ YES ~r0 ?
fiES~DENCE~TATE COUNTY GITY. 701NN OR LOCATION STpEET ANO NUAIBER ~NSIOE GTY I~MITS
FlOR1DA BROWARD LAUDERH1Ll 8321 N•W• 5~ STREET «'~E°~"~~
~ 14a. 14b. 14c. . ttd. . _ tta.
FNi}{ER-NA/AE FIF{$T M1DOlE LAST AlOTHER-NAME FIRST MtpDIE MA~~EH
~S EDWARD ~.A4VSON 16 GENIVIVE A~~DERSON II
fNFORMANT-NAk£ (lype or Pmq 1A/1iLlNG ADDRESS STREET OR R.f.D. NO. CITY OR TQWri STATE 2tP
17e DORIS MARIE DIGASSO I~W q~ 8321 ~d•W• ~1 $TREET ~AUDERHILL FL 33j5. '
UR1AL. CREMJ?t10N. REAAOVAI, OTHER (Spedly) C£METERY OH CREAIATORY-NMAE LOCATION CITY OR TOWN STATE
BURI ~~~UEEN OF NEAVEN FT• LAUAERDALE, FLORIDA _
I FUNERAL R--Sqn FUNERAL HOME
~ 7001 N•~• 4$TREET; PLANTATION, F~oRtnA 33317
To lha best d my knowtedpe. uxred at M~e .-te and place end 21a. On V~e bas~s W oxtrtw~atwn andlor rt+vesligatan. ~n my op+^w~ deatt~ occurred at
dua to 1ha ca~se(a) stased ths Nro. date and ptace and due to ttia cause(s) s+aled.
n ~d THk)? ~tuts ~nd Tlqe)?
pATE SIGNEU (6IO, Oay, Yr.) NOUR OF OFATH ~ATE S~GNED (4l0., Dny. Yr.) HOUR OF DEATH
YOb. 1 ~3 (a7 v:~lJF11~~ ~,1 21D. 2lt. M
iJAME Of A7TEND~NG PHYSIGAN IF OTHER THAN CERTiF1ER (~rpe a Pmr1 PRONOUMCED OFAP (Mo. Oay. Yr.) RONOUNCED DEAD (NOU,)
~ 21d. ON 21e. AT M
NA~JE AND ADDRESS OF CEAtIFIER (PHY&~CUIN. MEDICAI EXAfJ[ttEF~ (Trpe a A~Y+q
~$TEVE ABRAMS ilf.l~. 250U IJ• ~NIVERSITY DRIVE SUNRISE, FLORIDA
REGISTRAR Q DATE RECErvEO BY REGISTRAR(MO.. Day.
~ ~ 0 C T 1 6 1987 ~
1. IW.IE TE C (ENT R ONLY OHE CA PfR L?NE FOR (al~ ~ f~)/ tn!erval batwoen a~set ar~0 deatn
PAAi ~ (t f (~~v,~V~ik.~; ' f~ ~~j~
OUE TO. A CONSEOUENCE OF (Condition(s) xluch gave rese to caws (e) - L.ist u~+dxM^9 c~ ~~3 Mtenel hetween omel and dearh
(b~ M(~{N ~L~tf R~?7f~ `~~cfG1~7+1Ct e L~ n•
DUE TO. OR AS A CONSEOUENCE OF Intenal bet~+eM o~se1 aM death
(c1
VMt OTHER StGMF1CANT COri01T10NS-~orWRvns tontr+butinp M death but not rNated !o VART NI IF fE1~AAlE WAS TH£RE AUTOPSV C~?SE REFERREd TO LfEDICAL
H grven in PMT t(a) A PitECiNANCY W TH£ PAST J {yes p Adl. EXMlifff~peNY yas a^01
t~AOKn+sa rea O rro D ~ IYV ~ ~~n~
IF SUR(iERY IS MEN710NE0 IN PART 1 p p ENTER CGNWiION fOR Wli1CH iT WAS PERFOF~AtEO DATE OF SURGERY(IAo., Day. Yr.)
77a 27b.
(Pr~?yWy) ACC?OENT, SUlCtDE a DATE OF INJURY /Ato Day. Yr.l HWR OF ~K1UHY DESCRIBE FiOW INJUfiY OCCURREO
Fi01AIC16E a INiDETERM~NED (Spectly)
28a. ~.b ~
INlURY AT WOHK (Specly PIACE OF ItUURY-AI liorne. larm. sUeel. Isctory. on+ea ~OC~TKNi STAEET OR R.F.D. NO. CITY OH TOWN STATE
ras a No) b~~MC~9. ete. [SP~+~Y)
~ 28e. 28f. ~0-
I i ~J~~ - EERTtFtEO COPY -
CT 2 ~ 1987 rH~s ~s~ ~r~R ~~UE AND CORRECT COPY OF THE OFfICIAI RECORD ON FILE IN THI~ OFFICE
EOp~c ,J7g ?,t!;E ~7U1
` ~~ZHE~ * B ~ ~ OIIVEH H. BOORDE
9n _ State Registrar ~
~ o • ' ~ ~ ~ OifiCe ot Vital Statistics
~ ` 6~ ANY REPRODIlCTiON Oi THS DOCVMENT ~S PROW81TE0 BY UW DO NOT
J WA~NII~~r1• ACCE~T UNLE59 ON SECURtTY PAVEp VYfTH EN6055E0 GREAT SEAL OF TNE STATE
- OF GIGRtpll AIiERAT10N OR HU19l1RE V01W T1q5 CEHTIFfCJ1T10k. a~*M~
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