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HomeMy WebLinkAbout0305 ~ ~ • • • ~ ~ ' ~ ~b'~: ~ i : , r _ . . _ _ _ _ _ . _ - - - _1 ~ OFFICE of ViTAL STATISTICS / V CERTIFIED COPY ~ F~ ~ nn(tGS.~ • ~ , Add Fe~ S _ :~c. Luc~ D'~c 7ytx C!erk o. ~,~.~uK E~~ L,c Tax 3 _ ~3 y - _ ; ~;t~~; ~l CERTIF{CA7E OF QEATN ~'i . ~'ierlc ;~~~k~= totw~iaEno. \ ,t~~ t FLARIDA T~'~ .t,;~sr'" ~ ~~r t DEGF.[rEN1~5 N~~1E f__ ~~UC+b! .eul ~ 7 Sf x~ ' ' Robert Richardson ~tale ~ O+N. 1l~+S t SOCULL SECUR~IV NUTAHER Sa AGE 1 ast A.r! . l lLUEO~ OFA1N '4aKh, *daY 5A UNPEA ~ YEAR Sc UNOE~ ~ Day " Novernber 20, 1989 485-24-OSS1 60 ~ ~D~VEOiRWl?~l~~M!~br) IPtRTHi'IACE(GrY~nOSplsaForqiCnu+*~71 NWASOEt;EDENiEvER1~iUS a~ -.:i: t4;: ~ ARR~ED 1~~ES~ (~!c a~ rh~ 1 Au ust 24, 1929 Geneseo, Illinois ; ~a P(/1CE O~ [7EATH (CMCA MMy dM SN nSMLtLt~n! On Otlk'+ ~~d.l 9b INGDE CIIY UMItS~ ~Yws rv rl„~ ' ~ r~o~w s; i~.~,~ ea,u,~r.,ba oo,,? oi?+~a NW~.,o a r~.~o~c• : a~,.t ~ss»~er1 Ye s nr iAC1l: ~ V NAME (1~ ncN e~aOkNO~. yv7 St~9~7 wr..f rtrnf~w) 90 Cf/ (Y 1I7WN, nR l C~CJIT ~1 nF OE AS N 9e f:CN'N t Y 1)~ nf l1111 ?~i~ p~ 279 SW Homeland Road Port St. Lucie St. I.ucie ~ i`~`~ N lM DECEOfN( 5 USU11 C~CCUPIJK7N 10b 1ttN0O~ BUS~NES577TfpUSTqV 1~ MAfH1Al STA]lIS -~lani~d. i? SUiiVtV1NG $P011SF (N wM. Vx mr..t~n n+nKl :.4 X` ~~+~rr'~~. ~ ~ ~ ~ af t En ineer General D namits Married Constance Haase t'~' ~~a pE3{DENCE -•S/AtE ~3~ CJl1NTr iJC CtTV. T=IWM.ORIOGT~O?J t~d SiREEi AtiDMUA18fA Florida St.Lucie Port St. Lucie 279 SW tiomeland Road ~ V~. MlS10E GtY t3t ZM' CODE N_ VYiIS OECEDENI OF li1$TANlC OFi HAIiIAN ORlGfN~ f5 RAGE - 0.mnkan Mdlsn. t6 OECEOEN f S E[X/CA1 ~pN r,; . I IMtS' (Ks a Y~ (5{x~rrJ?' ~~o m 14s - R yeispocAy~ Hrtia~. CaDan. Btact, WhIN. ex (Sp~cd~ on` nqnev g~a0a co~++r.ro0i :1~~I~ ''~9yl~a, : lleucin. AN~OV fLC~. elt 1 1XNo fe~ SAetA~r ;ts~~~;, Yes 34953 ,.n.f to e'"~,"~~'~'~' wko'r •~s. ~ _ at , ~i~a~ ~~r - 1 ~ i ~.s~ ~ t FATF1i_SYS NAFJF (ivtt. l1M}e. lss~j 16 wtU1HEP'S NAME (F~nt. i6cf~. MrudM S~nnMx~l V- - 1~~; Frederick Richardson Rosa Ikenberry ~ 19a 1?IFO~~MA?IT'S NAME (~YV~'~'^~I i9b f1Ari1NG AC~DfiES$ (Supsl and ~4m~tw a i~wN Ad.fe !NrnDer. Gry m ks?n. ShM. 7~ Code1 j Constance Richardson 279 SW Homeland Road, Port St. Lucie, I~1 34953 ~ ?ria A~ iHOU Qf UISPOSITION 20A PU1CE OF OISPaS11iOH tNsme d CerrMtsry. uemeArx a ZOc. iOG4 fOH - C+ty a k*wn Str!e tti} - ~ al~er PNece) ~ ~ ~ j,r~, ^ . ev~a! ~XCr~abon Renava~ Irom 5ur~ ;~o,~.~~, ~~«h«~s~.,~ fort Pierce Crematorium Fort Pierce, Florida ,'=ti ~ Z~a SIGW~TURE OF Ftk1EMl SERV'~C£ IICENSEE OR ?1b ItCENSE /Q1M8ER ?1C NAME Ml0 AQDRESS OF ~AC7t1TY ~ ~ PEaSON ACftti~ AS SUCN ~ , ~d ~'~""'~j Ya t e s Fu ne ra 1 Home , I n c. ~ _ ~ ~ uG lrt' ~ 1926 P.O. Box 717, Ft. Pierce, F1 3~i954 ' f yss,., ~ '2t~. ~b 1he !r! l nx~dg~~ Y 1Ne ~ dab p~ace ro tt+e YSa On IM basit o1 ~caevnalan rdia invstt~~on. n my oqnan dea~~ occ~r~.a r~ ;~i$ ~;i ~ s~ ~ared ~ ~~e ~m~ d~k ard aKe ~nd dve to IM t~s~fsi and manne~ as s~s~M ~ ~ ~I ~ ~ ~tuw ~nd TRM ? ur1 w~/ tRN ? I' 3 !g~ 2tD OATE NED fNh Uy, ri) ?2c HOUR OF DEA[H 23D. O~TE $1(3f~0 (lUO. Dry. ri) 23c ?t~DUH OF OEATH , ,tS~~~ a~ ~ a:oo p~, ~ ~ " ~ U s~~ ~ ' t?d NAIJEOFATiENDINGPNYSIpANlfOTMERTINNCERTIFIER(iypsorPnM) Ep Q30.PRONOVKGEOOFAD(?b.Oay.Yr) ?3e PfiCNiOUkCE40EAnIHn~.) ~ M f : ~oa ~ ~ ~c~ _~~1 ~ 7e N~MEANDADDRES30FCERt1~~R(PHYSICWi.MEpG?LEl(AM+NERt(]~yeaP - Dr, Allan J. Birnbaum, 1701 5E Hil or, Por St L c e F1 34952 ~ d , ~ ~s~, i , . ~ ° 75s BREpSiFiAfi-/S~1Gti /WOd1TE 25E tREOtSTRAA-$K3H ~ ~ pAtF.P .RSTE~fp _ ' i ( ~ ` tet-' ~ ~ . ~ ~ ~ ~1 l~ r~> ~ / F 4 ~ ~ ~ t 1 En1er Rw 6is~ase> i er tdrpiicNkx+t thst cnuce0 Ue d!atn. 00 ~at s~W~ tl+e n'w0e d dyinq. h a3 carbx a reap+r ~ a~nst. ~AOrt. or e App~oar*~sie k+erva~ ~ .t~ ~ biMw~ tM on~y o~e uass on ~rJ+lu+e. ~ B9~wCC~ O1~SN A~(1 ~ -~,',F' ' DCCd{h w.1\~fD~ATQ fj1UJE 1Fini1 ~s ~ :;;;~t~ : ,z~ ~3 Y - :~.a _ r dsam? s ~ ~ "~~rC.~ ~jr i : ~ : //_~~j/~ DUE ~D (OR AS A QOrtSEOl1EMCE OF) ~ ~ i ~-~,VC.~~/~l0~/A ( f . - Sw~yr+MrdVr IiS! CO~~d~hor!S. : ~s' ~~nny.isd0~~g bi~T~mBdats h ~ c avs~ EN~r l!?IOERIY~N(3 LWE TO (OR ~l9 A CON3E0UEltCE 0~ ~ C~U3E (O~sease a rtwY 3 op ~ ~.~,~,,~~,w~ ,B~orv~~oG~<G C~c~,t,7a.u~ i - ~ ~a~~, c~+sr ~ e ;,;~,,,~E : oue ro~oa ns ~ cor+sEOUEkcF oFl. 1 ~ ;if~h~:.~ = d ~ ,~yl - ~vnt n Ocne~ sy*+~ca~~ ca~du~ co~c.~oua.,g co dea~r, nw na resuh•~p ~ ttK ?70 MfA.S AN AU iOPSY 27b WERE AUTOPSV FINOHJC'S ?A CASF REf`O~' FO '~""3= i'EFifOliMEO? AYA~lABIE ~+MJit i0 C~OMOIF i~Ot1 TO MED~(:AL ~ unn,.r~yK,q c~ursR pnen ~n Pan 1 d'> /16so~Hn) OFCAL/SEOfOFA7H~(l~bso+No~ E%AMiNFR~ N~ INtwNn~Yes . _ ~q IF F~MA1E WAS THERE A 30a ~f SURGERr ~S AtE~iT~01:E0 iti CUIT t fr n E~:tER COrA~iipH ipR YtEUCH tt N[AS PERfORM£D 30b WiE OF SUnGER`i ~iJ^ t%+y ~hr~) ' ~REC>I~AtlC1' iN 1ME P~IST 3R~UNTIrS~~ ~YES ~i0 ~ ~ ~:i'' '<<t<~ . 9+ C170flA81E 6eANNER pF 32a CMtE Of ~'iJURY 3?b 1MtE ~ 37c iJ1}1JA'~ AT WORK~ 3?A OESGRtBE HOM! iN,N)Av OCCV~REO ~ ~l` C~EAiH t4Aaith. Gay. 'k~r) ~KNRV ~VH M NO) r~"rJ rcc~,+ w~c+ae a s~ : _ R'Y++.cKfl~D~undetwrmx:PQ M - 3?e PLACE OF fN.JURV - N henM. ta•rn 3?1 l0('.AI~ON tS7reN erd N~be~ a Awn~ Ram~ Nur.rbr! CeY a L~wn. Sf~tr) ° slre2t txtory. Mc /SO~c~Y1 ~~~M ~ '90 JA~1 2b P 2 :dil ~ , . . . ; d ~ ~ ~ . ~ ; dODIt ~7~ fllGE ~O~ r~T J~! ~ ' ~ ~h 1 ~ ~ LI if .~1~. . . ~ ~ THl IS A.CER; ~:LEO ?~t1E A QRRECT COPY OF THE OffiGlAt RECORD ON FtlE{iN ~7HiS OfFICE ~ 4. dtNfitT,~~? ~ , ~ ~;y. ~ ~._l~o+~Z- OLIVER H. 800RDE , ~ ~ BY r\~, State Aegistrar e A_ ~ ~ ~ ~ e AhY RE~AOOt1GTtCh Jf T!tf5 WI~AI#AErtT 1S PRO1-081TED BY L~W- 'J(1 NO7 ACCEA7 E:3 ~ s V~+~fSS ph SECJRY7Y PAPER '.V1TH GOLL)RED 8~C!(GFivUND RJ+O GOI~ E~JOS9£D GAEAT - - WARNING; ~ ~ ~ l OF T AT l . A R h HA„ E .i_ }t ~ c7~~F .JAT„iN ~ EA HE 5j E OF i OR'0 J~iTE .ATIO ' OR E ~UP , ,s. .J i4 ~c HAG fCPU '~.tA <8 wi~, S . _ _ _ ; _ _ ` ~w~*"' ~ - - - ~~E 6 ..4'j ' . r` ~ ~ 0 • .3'.;~'y ~~~•;i~~a•S~'~~` ~~.~r~. _ Y ,~t. F. 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