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HomeMy WebLinkAbout1664 • • - OFFICE of VfTAL STATISTtCS ` ~Fi~IF(CATE~~F DEIITH ~ FLORIDA ~ tXC RRS M~DLE SEx Ab~ ~..Zp ) 1. ~fWraCnll~ra [s.z~ra7 •'+~+VtV+ct Z~u7raiaC+. .t~ ~-l4• MArOb (~HDER 1 YEAR --UHOER i DAY _ OA OF I~ ap. K-1 AT ; M1. k~~ Nt (S~ I lLIOS DAY8 HOl1F1S WNS .c. ~ITfS. a.. 8~ se. x. ~ JAN[~RY 13 3905 S'~`. . r, r~ ~ n ~oe h s+ r~ e r y~?. a~..r a~d t ~ F0~ ST. f~7CIS H.C.A. MmIC~L CENl£R ~ ~L~4.~-)wo!?QOtMYj ~ Oi T OOVN Y ~ . _ _ _ - 9 . ~±e _ _ ~ ~ ~ ~~Sl~dl s_ U. S. A. ,o. I~ARRIID , i. JOF$$ ~R , ~ - AL AT10NfpM?~i~d dyy~ri~p~ Kpp o~os! W rvl~+p M~n / r~eFiQ/ ~f.'S- ~'O sz. oia~32-342o w.. I~xRS~I~E ,ae. c~4dv i~ ~.a. Ci~ 7ATE . iY . TONfN l T10N S ~ ~f `4( ,.a k3l~R1UA t.o.ST LEJCZE PORT ST. LUCIE ,.e148 ~STT,A I.ANE t.. J1T~$ AkDO1.E lA9i A~fOtHER- ~T*u ~ •'i 15. ~ f~LACSa iYE:ii~.J~71~i id uM~~77C[7.41~t1~W~ . _ . ~ 1P~ Ap?~1 KAILtN(3 S OR F.D. sVO. pW?~ ~ ti~. ~y.. J0~1 N~2ER ~~n. 148 ESTIA LANE PORT ST. I,L~TE ~7AR~D~;,, 3~49$~':: ;;<<' I4L. O (Spselly) CEh1ETERY OR T Y- ~ t i83, teb.~~r HI~aS a-au•~~ r~ 1aC. Psa[.~y ~..~:1i , t~;'; ~ ) FUNEFiM. IIOME ~ ~ , ~~/a1 ~ • 'y,~~~; ~ d~"`~ ,sb. FORF~T HII~IS AfE][~lDRiAL PARR PAII~i CI'CY; ~pl~YpA'~: ~AS~Q'~;d o n.s~ a~r ~~C~~eocw,.e.e w~.. .~a~.+e su. o~ r» a.ra.anscio~.rwra ~es ~r ::;1`,~ do. ~o Wt causKq Ms ~Mn~. das m.a w•n ~na dr. ro Ar auea{~I M~d ~ tYN?r , S . ~wl :+~Y. 1 OEATM DATE p1o.. Oq. ~-1 UEA i?? ~ " ~ ! ~ ~ ~ 20eq ~ 6: 5~ P. 1A a YtA $1¢ ; i , &CUw OTHE HAN CEqi1FlEA (I~p a F?Irr} F~ OEAQ (Rb.. Wy. r.) a~ry POd. ?1d ON 21~. AT ' i . OF TIFiER (PFIYSICIAt1. N1EDK'.AL E (1yp~ or AAUj l,i.,'; : ; t~a. DR 3 7 S. E. SAI~A F~1D S"I'Ci~1RT FIURIDIA 34997 ~ ';1. f ~ ' , x~.~E ein~r,r ?t~. ~ u~ ~e} ~1 I ~ r r f p4~ ~ ~ ~~7~+ ~Cr~/~ ~ ~1 ~Condtlonf) whid~ yave rise to Ca1M~ (y - LMt ~A~dMlyifp CM1M fa~t) b~~ M10~/ .`i~- ~ ~ J~~~/Q / -,`f'•, f ~ " , ~ , , ~ f,t /~?Q ~~~r~3~~ e~xu.vCo ' ~ b P~AT.t b ee.~n ew na rw.ae a att w wl~s ~ l~M'. W A PRE~3NANCY fN THE P S fyes a.~" ~XA1~OE~1(~y ~Ari~Y 1 / ~y~ ~ 1~qirT?+s~? Y.s O l+o 26. . IVIi . i~.1 . ~ ~ ~ ~ - . ~ ~NT M P ~ 1 p N TEA fOR WHICH 1'F W1~4 . f, ~;~i - 27s. 2TIy ,.M1 y 0? ~ a OATE OF MJURY (~b.. DeY. Yr.) HOUFi OF MIKJRY (~!1 ~ _ 2Sb 2ac. 2e0. g f~h -H ho~os. alrwi ~+ebry. a16ce L . ris a No) . sps p~ , ~ ~'~'~v. ~ f~o~~ ~ . ' lo2i~. g LZ.~ '14 1'k i':i. - _ ' ' ?~C~~! i~ ~ Xi,~l ' ~ THl6 iS A T iED TR MdD CO ECT PY OF THE OFftC1AL~RECORO ON FlLE fN TH19 OFFlCE f ~tTr{~ - y q, ~ ii f ~ ~ ~ BY: OL{VER i-1. BOORDE o ~ ~ ~ ~ State Registrar ~ . ANY REVROOULTtON OF TNi& OQCULff1T IS VRO~+tBITED 8T L!W 00 NOT ACCEPT ~ ' r WAR [V I N G• UNLESS OH SEGtJi3iTY ~ACER MtITN GOIOREb 9AC1CGRaUNU ANO CaO1.U f.l~190635> OFEAT 5£l~L , j . 1'• • i,y, • FW$ GO« 7561 ~d.27T OF THE STATE OF FlOfl1DA. RLTERATfOH OFt fRASURE VW OS TFfiS CEATtFlGAT{ON. , f . . . . . ~ ~ _ ' _ ' ~ 1?f ~ ' - ' - - ~ ~ ~ ~ ~ ~ i.~ ~ ~ ~ e S ~ BOGK 67~ PAGE~~U~ _ ~ . k,.-~ z..~,~.:~w~:~.~t~.,~~_~;~~:.~_.~-~