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OFFICE of VirAl. STATISTIC~ Foe f_~,,,....oDpU .~iS DIRON
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~ ~oc~~ FKC No. I~ I Fl4~A
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Walter Geon Beaumont Male
~ QA~E O~ [~EA7H A~w~M. ~q~ Nr) ~ SOClAI. $ECURITY NULBEA S~ /1~=l~l ~rMiOry Sb UNDER 1 YEAR Sc UNOER ~ Oap
December 17, 1981 102-07-8071 83
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.f October 2b, 2906 Brooklyn, Nex York . """~DFO`lP~'~'~'°'"°~
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~ t La~mwood Regional Hedica~. Center Fart Pierce St. Lucie ~
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Florida 3t.Lucie Fort Fierce 1230-D South Lakes End Drive
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~ Walter Beaux~ont Bridgette McSherry
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~t~th Beaumont 223U-D South Lakes End Drive, Fort Pierce, F1 34982 r~
~ : t0a ~IE I NOD OF dSV091t~ON 20D ~ r10tf Ml~ais of p~'"s4'% ~qwiWrlc a ZOc IOCJUION - Gt~ a To~m. Sure
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a~ae° "0'~`'~'~"~ Yatea F'unerax Hou~e, Inc. ~
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Michael J. CosteZ2o, M. D. , 2215 Nebraska Avenue, Fort Pi.erce, Fl 34950
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