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HomeMy WebLinkAbout0796 1022063 CERTIFIED COPY • ~'i , • - ~ 't " ) ~ 1, I hereby certify the 8ta8~nefile in ther8ro ardcCounty Publicf Local Registrar's recor . Health Unit in Margate. Florida. WARNING:,,. Not valid unless raised seal of the Broward County '~,:.pu4b1'ic Health Unit is afflxed. 0~~~~~~~ _ j , ~ ~ • ~ `d - • . - ~ ° 3/~7I3b . ' ~ % CHIEF DEPUTY LOCAi. REGIS'TRAR r=': • ~ ~ , % : ~ < , ip' ~ ~ d, ' ~ ~t _ C~` ~ ~ ~ ~ ~ Zec Fee ~ ~ DOUGLAS DIX~ ~N .•T' st ' i Adti Foe:,~~~8t. L.tiCie CoUnt~ . ~,~j~ 4 , _..l~.ti; 1' . I~oC T8Z Qetk Of G~rcu~l tt . o ! n t Ta= = By _ ~ , ~ . . T'.~ ~ ~ .N De1~fiY Clei:c ~...~r~.~. CERTIFICATE OF DEATH 'f""""E"T FLORIDA ~'kx ~ LOCAL FI~E NO. SEE ~yy,~~pK OECEOENT 4AME GiHST /a:C)i;:E IAST jF( ;~AT; V~ LG%~~H.t~~ =3. ~ :,sr,ucTa?~s , Rosemary Tt~rai]kill 7 Female .`tarch 10, 1986 AACE g K~~~'e B~a<w nGE Last 0 rtnOd7' UhDER 1 YEAR UNCER 1 DAV OATE P~ B~ATFtiM~ Dar i~ ' I C^vllkTV GF pER~~• 7~ ~~+~1}1Cec rsce~.~~, s~ ~~os TD4YS NOUas ~ M~NS , S~ x p April 2, 1912 .,d Broward _ CiTY TOKNORIQ::AT~O~iOCDE~'~~ MOSP~TaIOHOTNEHINSTiTUTipN N~r:e.!1.~..,~~~e~rne~ g..rsnee'a~~.~~~~~te• Ca:~.~.' 7b ; v •a_ .t,...•c_ Ft. Lauderdale . North Beach Cocimunity Hospital ~npatient" SlATEOGB~tiT/~ nu„• C~TiZfNOG~LHA/C:i14iRV tiIARRiED NfVEkMAHR~EO SUAYIVlYGSPOiiSE~:/w~e y..e^:a.,?^..e-e. 7~ 1 nm~+~eccw„!,,, W~^ NEO CLVC CEOiS:~P:~fyl ~ a~~iio U.S.A. ,~,`~~arrie~ Harry K. Tt~railkill s SOCIAI JE(:UHITY 1+UNHEH iUAI ~CCUPATI lN ~ Ci:~e ~..~y ~,l rn~~ , .r :'•,.r.n; K~ND 6f Bill:tii» i)~ ::S'Fv i2274-10-5525 ~a HOUSeWl~L@Iwo.,,9rre e.en •,c•.e~, ,lo Qwll ~~0[T1E.' ~ ~i REi~DENCE STATE CDIiNT~ CiTY T0IMNORIOCATIQ~1 STREETANDNUABEA ~'.S~CEC~T•~ . S.r: ~S . „Oiiio „oFayett~ „~Washi~gton C.}i. ,a~ 307 Staunton Jasper Rd ,_s f es - fNTHEN NAME ~IRST 6~~LDLE LAST M~?Tf~ER MAiUEN'~4ME ~IRST A~iDCIE .aS' - . ,5 Morris Langan Sarah Schuler > ikf OAMANT NAME i~Y[-r o~ P~~^r, MaiUNG ACDHE55 STAEE T OR R f D NO UT~ GA TG.ti^~ S~ATE I~ _ ,;Harry K. Thrailkill ~~~,3Q7 Staunton Jasper Rd., Washington C.H., Ohio 431~~ • BUaIAI (,~cMATiUN PE~OVAI OihEH.~~rc~l~i ~~Eti1ET.ci.VOFCREMATUNY N~~1E ilOC4Tip,.1 C~TVr~qTph!~ ~>'ATr - °~g' ,q~, R moval Darbyville Cemetery i,, Darbyville, Ohio _ • FUNER IRECIOR S. {VNERA~ ~fJ0.~E ADDQE ;S = oA ~V .Baird-Case 4343 N. Fed. Hwy., Ft. Lauderdaie, F1. 333~; f - ~ t 7 Tu tR ~est oi r~y Lno Qe OvaT C~nr tme oa'e a~A D~~.=-~ a~~ J-,,t~ 7+a O^• tw nas s oi c.am r3 :o ~ a.] s• ~ - '.c . . ~otnecaose~sl s~ate ^ o W ~~~^r aa!e .i~~ c~.~cr a^_ ....e t.e c3. s f oq ~ nNw~ an0 TK4) P I a ~ /~hj ~ Z (Spnilun ~nA T~Ne) ~ t E> - ~ ;ATE SIGNED~.1IO Da~ Yr ! NOUN Of L'EATM oY D4TE SIUYED ~A!o Gai ti~ • C: n ~ _ VO F : 2L 7}_ 11: 35 E1 M r.~ ~ _ ~ EF 1UME OF ATTEN!;IhG PN~SICiAN IF VTHE~7 ~~~eti CFFTi~iER ~T~pe o~ Pr.-~r, EO GRONGU~+CEU C£AC ~Mu Da~ r~ ~ F~~".GU'.-E~,~ CEEC~~c~..• f - iW ' ~ :ou ;~a n~: rc at = ~ NAMEANDADDNESSOFCERi1FIEAIPMYSIG~AN MEDICALE%AMWEA+rTYD~aD~~'~'/ - z:1'r'~~t~,~K P~- 'Socc• • E.2~r, ~ C~ REG~ST%~AR . ~ . • ~ ~ ~ DaTE AECE~CED Av RE~;~S?naa Mo Oar r. , j J/ L ) / . ,3a •S,q~a'aie~~ L L~u ~`Y ~ , i ~ f z3~ ~AR ~ ~~966 ~ N iMMED:ATECAUSF ' ~ENIEtiON(vGNF ~USfPfHtINEFOHra ~D~ ANDrc~~ ~~~~'~~~•~~~~.~•'.~~~~°~••~'.a^"~ ! ~ ----I o,~T ,a,!'~~.~~v ~ ti7Y.' N~ ~ ~ ~ ,~~1_ ~t~=n~r;; r.~'rr~-G~~~ - ~ ~ a~~E t0 oQ ~S n CO~+sEOU[NCf e~ (Conarto.ys) Nn~cn yave nse ~o cause (a) L~5 ~noe~rr,q cause .asi) I.''i'•J' :~'rai.~" : j^' ~ , n ~~~i~~ ~ v L t"t ~ ~t1~ ~l (j' ~~`f" G f~'f ~ I ; cue To vaa~.nr,u~.~t~,uc~u r:n , ~ 24 ~ i ~ - - ,c, ~ ?AA1 ~ r .:.~f1- ~.t~' - r. , t..• . . 1. . ~ 1AH:'., OAAT W!f iF!l':,~ f.a'. " _ - . . ~ . ~ ~ ?_71 p , • ~ , . ~ . . ~ yt, ::N.~ ~ ~vr„t,anyi ~r_~i~E~+i F,uiGiDE o~ ~ATE Of i1+JURY ~Mo . Day. Yr ) ~+OUR CF i~+~uRr OESC~~[fE Hcw i4.tiAr OCCUCU+E O ~~OMtG~DE o.UNOETERM:NEC~S~rc~ryi r 7fl ~ 77a 'in : M 7;J ~'.SFOITSIZ. ~NJ~IHYAIW()tit(.S[rw<~!y 1'lA(:f1;iiNiliNY Alr~...,~~~~ ...~.1~•.~ ll'c.1flt~r~ ..71ie4ic~11f1F(~M:~ ~~~i~~~N',:/~ti _ _ ~ 84 ~~30~9t@S qn tr Akn ~.y • . . ~ ~ ..-•:1~~C1US l~1110f1S 1%r : n .''J ' :.~1 12-31-BI - 1022Q?8 3 ~ '90 JAN 29 P 3 :33 ~ ~K ~ - • 1_ ~ F , _ ~ ~t~~ . ~ s S i i ' ; ?j ~ F 1 BQGA 675 PACE 7~~ ~ _ . - _~~-~~F.~ ~ . _ ~ ~~~~4~_