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HomeMy WebLinkAbout0303 : j . - ~ " "s s • • ~ ~ ~ ` ; ; ~ - - _ . _ . . . - - - - _ . _ _ . . _ . _ . . _ o~ . OFFtCE of VITAL STA7tSTIC~ ~,.1L....._ Dc~tr t~4 hr•~~~; ~ Add Fi~ S.~ St. i_u CERTIFIED COPY px ~ ~ C1erk of ' -c„u ~ ` ~ ~ tat ~oc i .....~~.....ey ' CEATIFI~CtA~TE noFw OEATH ~ o ~ L~j? CI~eIt - LOCA1 fKE NO. ~ ~ rw~y~ ~ , ~ ! OECFDENI'S NAMf (frK N1atfb. ~ury 2 SE7l p= M. Vernon Jenkins Male ' .;s ^3 W1E Of OEAtH141xMK De~t M~V/ 1 SOCtAL SECtJp1V NUY~R Si af B~tMe/ SO UWfR t YEU1 SC 1JNOER t pap ~ 82 ~n ?~oun ~e, ~ ~T June 14, 1989 263-52-0775 ~ ~ 6 taATE O~ 81R1 N P~'~. ~ 16ar! 7 91fii?iPLACf (Gp ab S~W w~a~+p" Camerp) ! VM~S DECEOEI/i E YER IN V S Aii~ED i0YCE5) Ms or Ne) October 2fl, 1906 Vineland, New Jersey ~vo - 9~ pu?cE oF o~,vN~cn.~. eM, a+.. r.s~,~~uo~s o~ orw ~ay ae ~+su~ aiv ~w~is~ rtisr a~~ NUSP'f1u~ r~r,~~„ c~ es~,owvns.;a ~s oo+~ or?+ea : Yes ~ k+rs*w }+ow~. u nwa«~a ~ 30L~.? (sv.rrrl 9c iACKR'N NA1AE Mro[~frLiRIO~. yfN ~UlM~O~M+~~+?J Qd pTV.lpr4tN.0~lOCATlON OF PEATH 9~ COlN1fY OF OEAtH I,avnxood Regional Atedical Genter Fort Pierce St. Lucie ~Oa OECf0FN1'SUStMtOC(.'UPItiION 10D KkOOf8l1SINESS~NWSTRW t1 WqIfAlSTltiW-JNir~W. ~t SUHVIVINC3SPOVSEtMwil~ylr~+n~Ow+nams) H~erer I~N~ri~O. W1dow~d. t,~,~mer-operator tlotel and Restaure ~~.ersw~X» Harried ~ Dorathy Henry = r3. aESioE++c~ - sw~ ti~e. Cou?+rt iac atr, towrn+. Oa ~OC~ra~ tJ0 SiREEi A?~ HUYBEA '~z Florida St. Lucie Fort Pierce 704 South 8th Street ~ - ws~aearv ~v z~cc~ wi?so~a~NroFi«swwcoA+wtw+owc.w~! t~i7ACE-~K~nMd~sn. SIQEC£OENT'6EDUGT~ON L+,~?ts+ r~• ~bJ fSioeca nb w bs - M r•R ~ sw.~. ae.~. aac~. wn~...k. r~PK~Y d+h ~O~N ~,e. c«no~.reo+ ~ ~llss¢~n Rrra R+cen. Me J No l+ ~b ~+tr?: i Yes 34950 White a~~'~°""d~'' °i'"'~n~ps.i ' » Ff?TaER S HM~E(F+sC M~dtJ?. Ux/ M A1C11HER'S NM~E (iist ~~r1dl iYadenSurwntj Willfam E. Jenkins Idella Miner i9i Ws~iVilANt'S NANE 1~1T'~'~'+~'r1 ~9C MtAll1NG AOORF39 (SsNt ~nd N1~~ a Aa~f Ra,l~ M~rr~sc ~GtY a twr~ St~N, tV Doroth H. Jenkins 7Q4 South Sth Street, Ft, pierce, F1 34950 ~ ~i`a NEi?ADOf DISPOSItiON ~Ob D'LA(.'E OF 018pO6~T10NlN~Md~x ~+~+K W 20e.lOG1i0N-- ~ C~Y ar lfown. Stab Bu~•a~ ~ 1 QanrLOn r~ Rwnoral kotn StM ,.~,,,,,o„ ~,o,,,,,~~i Siloh Cemetery Vineland, New Jersey s+c~e+au~ os vix~w~ s~vrce ~~usee o~ _ zro i~~~~?reea 2~c NAAtE ANO AOOF7E530F FKy?~~Y Y ' RER9Ctt1 NGA65UCN~. (d(ioMDM) ' ~ ~ - - / - ~ ~ ~i- n~ ~ 4 ~ Yates Funeral Home, Inc. s i/~ • r'r-• ~~~~~~r~ ~ ~ P.O, Box 7T7, Ft. Pterce, F1 34954 2a ~ w o.x a~ ww~.wy., esae~ w. a~. ,~wp4c~ .~e a» b+n. rs. a+ n» w.~s or.~~~.so~ a~+a+~x ~e.~ i "0~*~ 9K~on. n mp opw+on dsath xcurna at e+uraft) ~s sawd. , 1h~ fn+e. Aah and pbcs rW dw w t?» e~~sl and mann~r r suMd ~ rrd turl . ~ ~ ~ ~ r~e ? 22D UITE SKsNfD (Ma. Q~t ~'t) ~c uWA OF DEA711 ~SI(1NNE0 ~lc ffl 23c MQtIFi Of DEATM , . z~ .l une 1 S~ 19U~ 5: ~u Q M , M ~ > ~ i E¢ Yl~, iUME OF ATTEMDIlXi PFi~~IQAN {f O'TNEq 1FW1 CERi1f1ER (~q dPm9 ~~?9d PRONOUNCEO DEI1D (Alo. Uqc li} 23~. P1i0?ApUNCED DEAD (HOV1 ! ~ M N MME MID A~DRESS OF CERTIRER {PHYSICLW. ?1EOtCAI E1(MUNERI (lj'Pe a~'+^~) ~al~= Shaik A. Khuddus, H.D., 2215 Nebraska AvH~ue, t. Pier e, F1 34950 SK3 ~t~ e' 25 , EGIStFUW - SK31~ttRURE /1N4 UAJ 25p IOGI 31GHIRUpE pl.Tf REC3tSrEAEU ! : _ ~ /G /Q ~ - l~ • . ~ ~ s <.aJ ~ ~ ~ ? ; ' ART 1 EMM t?+~ bslesss " :~s. d oa~canan Ihal ctiW W IM dNlh Do nal !nW tM mod~ dyr~Q. a! u or r ~sf~n lb~ ori~ v?r cacue on NcA &~e ~W~Y vrW. . a Apprac.nah a~ ~ 9ahrlen ~n0 • ' De~td ~ ~ nauEbutE CAi15E (~,nal / ~ esas~e a wnd~on `tJ._ L ' ~ F'r~~~~ : rasuRroqind~alh) "A' a CW' _ ~ V~ ~-_yt~~.- ~~1~-1/( / I ,l'"'~ OIIE 7D tOR AS A y ~ ~ ~ ~ f?7,,~/ ~ SaA.~erxia~lY By~ cmtisAOn~. • ~ ~ r. ~aen,g w~c~s e V'"`- ~t ~-i..V1 tll.~Ll~'~ ~ E~ wwea~r?NC~ oue ro cofl ~s ~ o~: cAUS~ (Des,,. a .~ury . : ~ f;~~~,tit ~ f~-C' ~ 7~~,,~ ~d-~-~s~. ~ ~~~.^~w ~ a•na usr ~---r, toR ~s ~ ooreseouFrr.,E oFl ' ~ ~ o ~ ~ C~RT 0 OV+e~ aprvGc~nl to+hi~tiont coMnb~dwq lo dYaD+but rq1 ~tyyiMg ~n tT! 27~ YlI~S AN AV ~QPSV 27b WEpE AL fOPSY F~itDINCS 18 CJ~SE REiOHTFO ~ t~~~t~:~''.. underM^9 c~u~ 9~^ n PEFiFOii?~ED'~ AVIVIABLE PF~+OR ZO (701+tPiETK3N TU 1~1ED+~.:AL p tr~"~'~> (1b orNe/ Oi UUSE OF DEATH7 ()bi a No) E7lAlIAthFR~ w`_. ~.t~~-~C~C1!~--C, f_~/I ~18-VL''-~ . No ~waai+o) Nl.~ ~ 29 iF ~EbfAIE. VYAS TFiEitE A ~a f 9UROEpY 1$ MENiipNEO IN WtAT 1 a It ENtER CONptTiOk iaR W1MC1i It MN~q DERFpiMEp 30h pATE OF SUROEiiY (AIO Oy ~4s~} ' ~R£GN1~N4ti tk 1 HE PIIST ~ a; 3~MONtN.S~ f: rES NO ~ Jt PI10BA91E F/MiHEA OF 3?a ~ATE OF MIJURY 32b iNdE OF 32c 1N.N1HY N MlOiilc? 32d. DESCf~FBE NO~Y tltAtRY OCCUR~IED ~ s l~J?iH filor%A. O~K Ulsr) M1,IUITV (?VS a No) t s~ i Spntlr) kctdeM. sukJde p Tf - rn~xx~de. a UndNe+mh~Ed ~ VI~GE OF t1~tlRY - A1 har~ 1a: m. J2~ lOC/1i IQN (Sf~ef t~d Numba? o. it~+N Fio~N NurnDer, Crry a Town. Stsh) - - sMM. ?scfory. ~tc /S~+eefil . ? 1 ! A ~~~Ri 102~d 1 ~ t~~~ ~ou~=t ~ `~c.;h . o a ~ , ~r = : ~ . . ~ aoo~674 vacE 303 € = TNIS IS A CERTIf1EQ 7RUE AND CaRR COPY OF Th~ OffIC1A RE O ILE IN TNIS OffICE ~ ko ~ 4 ~.~1.~+ . BOOR~E ~ ~Y«~ ~T~;~Tp~ ~ / ` r E - ~ BY: tate R strar ~ ~ ANY REPROQVCTIOH OF TYC3 L7~7OCLMENT 19 PROF481TE0 8Y UW DO 110T ~GGEPi , WARNING• ~E35 ON SEGUP~fY PAPER 1N1TH Ct7lORED 6ACKGpOVMD ~+OGOIDEMBOSSEOvAEff ~ • S~i Oi T~E 3T~TE OF fL~i+DA ALTEAI~TKNv OP EAASWE 'JO~aS TH~S '.cF'~~C~?tr,.j aw.RM~i~sNi~ur~'s : . ~nrnt ~ I :tAS FCw?`a ~a-!r. . , _ . ~ _ - . . . ; _ :.,~c~ -=+.v~ ~ . , , , ~ ~ ~ . i ~ ` 11 , tT-{ ~ ~ _ ¢ ~ - =r