Loading...
HomeMy WebLinkAbout2461 , -1, Cc~..ti v~~-~~'-' ~ ~ ~ ~ ' OFFICE of ViTAL STATISTtC~.c F~.= ~DO LA9 DIXON ~dd Fe~ i ~.-~-...---st Cc?ancy CERTIFICATE OF DEATH ~ T~ i C1erk Circuit Cou ~aµ ~E,~. e~.~ 8- Q S F L O R 1 D A lift Tix s r,-.._~ By DECEOEN~-NAME ftRST MIODIE LAST SE7f , OATE Oi OEATH(40. ~C~ ! t ~ rtli~iu.'+R Lt1 V la./JIA~ 7 ~ ~ ~ 2 1 O S sw~ RACE-~ 4. WWN, B~Kt AQE-1~s1 9utlW~y VNOER 1 YEAR UNOER 1 OAY QAfE Oj 8ti#THf~. DiL Y~ 1 COUNIY OF DEATH ~ ±L Am ~I~Mx.Mr~ ~IC (SpK~t/~ ~Y~i ~ NOS ~ OAYS ~~OURS MtN$ o. s+rt 1~ S~ 7 Sb :.c k~ 6 7~ Cr7Y. TQYVN pA IpCATlON Of DEATN ~qSPtTA~ (?H QTI~ER UI~OIi ~ N~m~ I/f ~d ~~tM~. ynv u»N ~naf iwnMr) IF HOSV. OR IHST. ?InO~c~l~ DOA, OP/EiMr. M_ MpNbM fSAK+~r! • 10 7t 7d BTATE Oi 6iRTHftlnd In C~71ZEN OF WNAT COIfMTR11 ?URAIED. NEVER WIRHIED. SURVtVWG SPOIx''sE(If ~if~, yir~mWM nMM) U.S.A. nrn?towttry/ WldOWED. DNORCED ~t'y) 6 e. 0~110 9 ~o » N A $OCIAL $ECUitlTY NUMBEA USUAI OCCUGATIpi fGM ~ind o/ nG~ dW» du+np KIl~ Of BUSNYE.S~ Oq II~LjS1AY ~MW~f s/1rOrtrfQ Id~ I~M~ h«dl ! 362-OS-6496 ~k »e. RfS1DE?!C£-STATE COUN7V CfTY. TpNMOA LOCAT1pN STqEET ANp MWgEJ1 1J:o:~E Cttf ::Li175 tsp~dy r~s w ivo~ Flori ,•e. ~a. ?.e ~a. fAT1fER-NAA~E flRS7 u~DOLE IAST ~dOTHER-WUDENNAYE FMST MIODIE 1A51 • ' ~s Hcmer' Hurd +e Wf0/1MANT-NAME(f~ w 7nn!) W?1{.ING ApDRESS STREET OA R.f.O. MO. CITY pii TpWl1 STATE ZIP 174 Il ilaV , n 170. ~ BURUI, CNEJiAATIQII, qEMQYAL, OTHER ISpcAYI GEYETERT OR CREIAATOW~r_ u$OZeLIII1 IOCAttO.i CltY OR TOW!! BTATE ria F~t1 ,~e. ,eo. ~ cu?+Eau. ou~cT -tsr~.rw.~ ~e~n~uu ?~o~.f AYQOC.'EC FVNERAL t~'1'L ADOf~~ , 950 P~ Jensen Beach Boulevard en Beach FL 349S7 ~ ° ~ 20~. to t1r bH oocurna tl . ,ne pua W ou~ Zta On tlr Oa~b a nea~Mroon u~d/a kNwt~lbn. in inY cWdp+ e~un «a+rr~0 at ~M - Y b M. ~e. a~ t+~w.. a.» .~e w.w .ne e1u. b tn. a,w.f,> .ue.a. ~ t~+w~..wnw~? ~ ~~+.e*w.~? ' W?TE O(4a Oy. r.) ?~OVp 0 OATE SIONEG(YO. W~. Yi./ ?~OUROFCEATH C w Z00. IOt. • 71D 21c. 4 E~ liM/E AT7E ~IO iMYSICIIW IF OtNER THAN CERT~i~ER f?YM a F~~l E~ a10MWHCEO OfAO f~Ma. OaY. Yi.1 ORONOUMCfDOEADfHOUr) ~ x ~Od. 410 ON Tla AT M NM~1E AHD ADORESS OF CEATIF~EH (PHYS~CfAN. 4ff O1CA~ EXAAnNER1(Trp~ or p.nr) . n. Cotler M.D. 500 . Osceola S ~ REWSTRAR ~ DATERECEiVEOBY1iEGi5TRAA/NO.O~y. ri.) ~,S,,,v,~,x., z,,. March 16, 1988/,~ 2t. IMA{Ep11TE Cµ15E ~ENT£R ONLY OlYf CAUSE PfR ll f0 f01. AHD / 1 I I Irq~rrY WlwMn aMN ~nd O~aU~ _ ~';"t /~ic.'L~,.C/ Gc~-~tGC~e-t c,~.~ c.~-v ~ ~ K/~l 01JE TO.OR AS A CONSEOVENCE Oi: ) wftiCll Q~v~ rt~ b CMAe - liM v~d~rlyirq ~~tM {bQ ~~o~a an.«n a+~ a~d w•n~ D I~ ~C/ C~'Ct' 'Z" t_ ~ pUE T, pR AS A CONSEQt1ENCE ~ I uK.na wn...n w~su sr,e aun ( _ C ~ !MT Ol11f~ 90MYKi1hT CONO~Tlpt3--~.a~aas tav+GA~q» bA~ W'+o~ tiaW W t~er py~n n V 1 pp ?~R'f O if FEMAiE 1MAS iNERE ~ AU70pS`I C/~SE HEPEIWfO TO YEO~CAI ~ ~j~/ ~J _ ) PREGNANCY N iH~ G~Si ] MWTH57 ~~cl ~ - V~(/' j/ i" / GL~~-C'[~'V ~i~iC~l t~sO vo0 7~S IYO a~ 1VOt3io~oh?wanW (F.ab~ACGOEMT, st1~CroE a DATE OF lNJlniY (Mo . Owy. Yr ) ~tcxtn ns i r t~cv:nroE ?+ow n+n~~ OCCUaaEo s+OwG aunOETEHwtkEOfSp~ary~ ~ ~ I/a 21D. ~TC L1 2I0 . ~ ~N,7lJRY AT WpRK $p~tAr pLAGE Of MUURY-At ~om~, lym,, a~~wt lactay. W~~n IOC~'~ON STitEET OR RF.O. NO. C~~Y Oit TOYVN STATf ~K o+ Pb) buWu+p. Nc. ISp~u~Yl a 77~ YN ?7 ioz ~ i~~2 ~ FiLc:-? ~•hC ~<E+~L;-. A ~1 4f~,, BOGK~ /4 PA6E~`!~~ CERTtF1ED COPY$1U~U~; .~.~X j'N~~',~~ . TNlS ~S A CEATIFIEp 7RUf M1D CORAECT COPY Of THE OFFIClAL RECORp ON FILE IN THIS OFFICE ti,g.~~~,~" . i`:``,.a*,~";i ~f'iHE Sj,~T ~ /J = ~ 4 eo~, 8Y: Q t-~.:., G. ~ C~<-C.,/C..C OUVER FI. BOOR~E c` ~ o S~~c~~ State Registrar _ Office of Vitel Stetisiics n J j ' WARNING. ~~~~T~ ~ THS D~W~ENT t$ VRp?i&7ED Br Uw pp NpT ~ AGCEqt UW.£SS ON SEC11RfTY VAPffl WiT?t E1~03bFD 6AEA7 SEAL pi 7HE 97ATE ,/t I~` OF FLOWDA. AITERAT~QN OR 6tASUNE YO~DS THIS CER?~iCAV~~p s ~l.. ~.,+-~c ~ -or - > - . ~°~a wczwc _ _ - - - _ _ ~ _ ' ~~.::r a 7 ~:`P'7' 3~ . _ , - \ • • O R s~ ~ ` ....c G,..~n titilllA71 - . . . ;