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CERTIFiCATE OF DE~. ~
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iNK ~ Francis Stalwart Davis ,Male November 24, 1984
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White ~S, $2 sb~~ , o~~s ~o~RS, M~~:~ pDecember7~ 1902 St. Lucie
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,o Fort Pierce << 711 Beach Court , ~l/d
STATEOf fl~NTn.i~ap~~r. CtTi1'tNOi Nrr+ATCUt~NiNY AIARRiEO hEVERMARR!ED ~URV;':.Nu~POUSE~~r+4 ~.r:r,~JS~~~,a.mr.
U S a n.~~e ca~~~nr, KtDOWED DiVORC D 1S[+ev~•~ri
B New Xork a U.S.A. ,o Marrie~ „ Florence Agnes Hern
~'NQE~~ ~y ' SOCiAt iFCUR~Tv NUMf1ER USW~ QCCUPAT~ON~G~re ~r.~00~roi~ Oo.'~O ev~~-~~y K~ND O~ BUS~NE5S ON iNUtiSTRM
' 'U'~i.i~i npsro!wO~Y~n l~ s~.2:;~l~er~ibi
~,l 262-66-2768 ,,,Retired Deputy ~ourt Clerk „oU.S. Federal Court
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~"CEhCE1TEMS RESiDEkCE-ST~7E COUNTv GiY TOWNORtOCAT1pN S7REETANDNUMBF~7 ~NStpfCIiVUMITS
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. Florida ,.oSt. Lucie ,k Fort Pierce ,.,711 Beach Court ~t
- GAT~~ER NAME f.RST M1DOlE IAST MQ'NER- MA~CENN~ME fIRST M~DDIE LAST
- ,S John Matthew Davis ,6 *targaret MacDonald
. ~NfORMAN?-NAME!Typeo•p~,-:r, MAIL~NGADDRES$ STREETORRiONG C~TYORiOWN S~ATE L~
Florence A. Davis ,;~711 Beach Court, Fort Pierce, Florida 33450
- BUpiAICREMATtCN1iiEMCYAlO1HEF~Spea!v~• CEMETERYORCREMATORV ~NAME LOCATION CITYORTOWN STATE
_ ~ ~ Cre~ation ~?isley-Nabbs Crematorium Fort Pierce, Florida
= NERAL iRECT0~7~-iS. • a~ ~ FUNERAL HOME ADDAE55 3p15 Okeecho ee Roa
- , ~ ,~,Haisle -Hobbs Funeral Home, Fort Fierce, Florida 33450
- i 20a iu trx o1 my tn ~en eatn• c t t tw~e. d n0 D~ace an0 Oue t 2ta On tne pavs ot e,am:naaon ana. or ~n.ezt~qat~ort ~n my op~nan aeat!+ ocw~rod a~ te+a
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~ DATE 57GN ~u~. Oa ~ l MOUA OF DEATH DATE SIGNED ~Mo Da~ ! MOUR O~ DEA?N
Y
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EF hAME OF ATTEh~~NG ~MYS`CUN IF OTMER 7HAN CEpT~~~ER fT o~ PROHOUNCED DEAD ~MO Da~ Y~ i Fa~yOUNGEDOEAD~HO~~i
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~ ~.AS~F ANC ADDRESS OF CEqTIGIER IPHYS~CIAN MECICA~ ExAMtNER)! iypt pr pr.n!)
i ~z Alan S. Collin M.D., 2215 Nebraska Avenue, Fort Pierce, Florida 33450
` - REG~~STqqR OATERECE1VE08YREG~STRAAtNO.Osy Yr)
-,~or~orvs a3a,s,~~.,".a:? l~~ ~ ~ U l.syl zso November 27, 1I84
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DUE TO. OR ~S A CONSEOUENCE OF ~ IntKrai Detween onyec anA 6eatn
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~7r~pa0~~1 ACC!OENT SUiC~DE o. DATE OF ~I'1JUNY (RIO-. D~Y. VIa NpUR QF SN}URY DESCRiBE HOW 1NJUpY OCCURRED
hObhC~DE o~ UNDETERM~NED~Speo1~1
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_ j q 5' 2 tN;URV Ai WORx r5px~~y FLACE OF iNJURV -At ~pmt farm str~el. ~xtory o~hc! IOCATIpN STREET Op R F D NC C1TY OH TOYYN STATE
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; n~reoy cortity lhls to be a trus ant! corntt eopy ot tt~ I~ota~ St. L~~cie Connty
Re~qistror's r~oord On ~If in the 5t. Lu-~e County Health D~pstt• CT~ik oC Circuit Goutt
ment at Fort Pierce, Flor~da t'`'
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~1~'larn~ng: Nof va:ici u~.: .:..ed seal Of the St. I.titl~ peputy C1etk
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