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HomeMy WebLinkAbout1244 Y` ~ ~ ~ ~ • ~ ~ ~ • : - - f : . , . _ - - _ _ _ OFFICE ot YtTA~ STATISTICS CERTt~tEO COPY ~~Tr~ ON Bae ~lr. _ ._.1L~°- - ~,t~~'Y, ~ F« 5~ ~ • ' ~~~ntv ~ ~e~a= D~cc't'a#c f ~ :t ,^.onrt x ( _ CERflFtCATE OF E)EJITN Iot'lUuc ~ L:. ~Y r_~~ ?ouu ~a~ No. Y ~ `P ~sto~a c;,~x ~ 1 OEGEDEH?'8 NANE IiirsL ~WOrA! lu.ry i•~ 2 SEl[ t ~ , ~ MII~Rk~ tiQ[JG~i i Femile a O~a6 oF OEaNtNa~+~?, D~r wv! SOCS~I SEtuatv NVMBEA sa. ~ ta~ e:~ SD UNOER 1 YE/1N sc ut+oE~i i os~ ~ ^ 3ANUARY 13, 1990 57$ 22-3732 85 °m '~~^~•s ~L r N 6 bAl E OF 8~H PMa~ML Dak lbv) ~ HWiF1c~lACE (Gh Md 3n1~ a ' if S,~k~,= FO's71A~"k?9 lV1N~SDECEDfNiEVEHM~US ARIdE_Q f O~CES7 (Ns er No) Au~us~ 21, 1903 Abexdeen, North Carolina t~~o 9a P? ~CE of oEwtH {GrU~.M, ae.: .e. wo~cnm. m aon..,;e,, ~ 9S.WS10EpiYlN.M1S~(~btdNO) ~ ~ F+oswu~t. rr Etvo,rp,~ww ow or?+Ea- t~ er,.a+ap xo~. E i a~a«,e: r,oa,a ~.uryl YeS _ 9c ~t!cRnv w+r~ p ~a rsu~uroR. ~,a+m.u wo.naeey ~,t. G~n, tp~n+. on ~orwi ~aw oF oel?tN s. oour+rv oc oE~~ H ~ ~ ~ HGA PQR3' SAINT i,tfC1$ HOSFZTAL FORT SAII~T LU IE. AINT LUCIE ~ ~ • .K ,ou. oec~Nr ~s uswi ncatr~noM ~ a?a a Bus+?~sanNa~src~v n ennsu~ suius -ww~ee. .z_ svw+m~w svous~ ro »~+k v+~ ~ , ~ r (yrK ~ "='S` Personf3el. Uni~ted States ~ fr.~!~u ~ L~J ~y~~ . - . ~ Superv~ sor ' rrnient Widc~w~od N/ a ~s 434 HESM~NCE - S~5 1~ COUGTY 13c ptV, IOMfN. OH LQCJ1TtOf1 t]d ~iRE~T ANO MIMDEA Plorida St. Lucie P+o:t~ St. Lucie 3009 Sfi Qvexbrook Drive ~ ; ~~i ?NS~OE GlY 13! 7Jp' COOf N rM1~T OECEDENT Of. W3PAN~C OR tiAtlWi ORlONIT IS RACf - MMntan Maian. t! OECEDENt'S EDl1GU~ON *~is lM1i$~1~YS0r1bl frOOrlbS-s i tf~llt~ll.CYlOML VMlill.llt_ ~ _ l+ (SO~cMr «vy i~M:t gnoe ranMetee) c~~~ EMa~oRle~i~. Ne)~NO ± 1 Vet ~r No ~ 34984 0.~+~.nr,rs.w~rr ~n .ys _ ,1~,~ so.~r 1~tite p. ~ 4 . , ~7 fAT?~ER3 NA1A~ jfes~. Ald~4 LaseS IR MOTNlA'S NA~fE (iksi. AAi1d~R MaA~n Spmrr~l " ~ Danie~ B. Carc~abell Mary G. Unknot~ . ~ ~ ~ ~ 19s 1?iFO~WwN~'S NAkE (1bobQ?fi9 t9b ?NtlL3NG ADDftESi (Sf~etanAlVwaAS~ arltrvtliOrYi?Mir~tMl or Town. Swl Zb Coor) ~ohn ~casf.rx3ton kt. 7~ 8ox 530, Gaffneyt South Carolina 29340 ~ ~ _ ?tH ME{NQp OF OISPOSi r!O?1 . Zfb RAC£ QF 015P061T10N tNfnf aI ~eVN.y c+f~K w: Iec !Dp?T10N Gry a ToM+. Siaq i '_~~'~'s'~ _ ~ 1 ~.aN r.S c.N~w~a, t~R.N,nvar eom sr~e. °fhs`pwqi - . - ~ . ~ . . ~ I,afayette Me~rial Park ~ Fayetteville, t~orth f f Mwafit.h ~ f t Qtp~~ RWti~ ' - Carolina ~ ' 2~e 31G W1illilE OF FUNEfNI 3EiMGE LICENSEf Op zw uc~+sE ~ ~~c t+~ ~no nna~sSOF r~At~Tr ~s~oH~~ssuc?+ ~+~o.~,w AYQOG'R k~I~RAL Ei~'~ 15U4 SE FZores~a Drive ~r` ~823 Po St. I,ucie Florida 34983 ~;ai ys a d» bes o~.y ArowbdQ~. aetn ~eweed r Ms w,d. da~s w pac~ erd du. w ths 23~ On n» bsl~? N~iamR+rtion.~r ~rwea~iyMiei+.ln rer ap..on a.a~ occur.ed it • s~A~+# ~u ~~4{1 as pMed ~ tl+e IinN. ~M ad pa~nd ~us b IM wuN~ ~n0 n suNd ~M iitl+ ? u'~ w! TiiN ~ ~ ' J~t = . z~s naE s~r3?+Eb N~a, a~c wl m?+wa oF oewiH rae wrE s+a?+EOra. o~: ri) tae. ~+o~ oe~rH ANU lb • ~ ~ ~ 1 a~ 2M: NA?AE OF ATTE/IU1NC3 PM~3lCllW tF OTHEA 1Hnti CEf~TJ~?Eii lType a Pti+fJ a~ "l3A. 9RONQUNGE4 p~AO/Nu r~1 n1 23a PRONOl1MCE0 DEAD (?b~~r) i ~ ~ ~;y~~;~ 3 Y 1 • M~. ~ks~ y_ z..?~uE~r+~~ar~sst~c~~~~p?nsscuw.~ac.~~ex~u~t~o.«r,e~r! ME90-03I-E FREDERICK P. HOBIN M. D. M. E. 250tI Si~UiH H STRE$~ ~ ~ ~~3! S~NS~MR-SIGWV ANDCWE ?Sb~~fCdSTFtI~R ~~/1 yj ?Se.OATEREG~ST~O ~ ~ ~ r ~ f JS..~L~_ ~ Ia P/1Hf ~ en~er Ihe ai~.ssa ~+u~ «conipkatlorv o+x os~.,.a n+. ee~ut oc na «da. u» noa. a as sardK ar ~ _~;..'~3 ~ ~tikx~ !~q i~Y ondtat~ 0~ sicq M~s. . . [upirMpY snest. ahock. a Appro~m kNSrvsr _ ~ ~ B6iw~sn aMf , ~ DlMh ~ ~ ~ ,f,~~~:~* Ma~Ft~tE aU6~ fFinal ( ' s_ i. dittf~ Or Cardrt~On ~ t~ - rE•~yyy~ kt MAf~) ~nT y~ y'' T vl~ p ~ ~ s ~ ' ~ t CM1Ji~GGi~1C .SIiVC[~ Df1E T'0 t4A A.S A OOltSEQUENOE IIFl ~2 ` ~;~,~,~~,h~,.. "~0 J~#1 3Q~ A11;36 ~ ~ - Jany.l~dRqbnvwdW b ARTEEtiOSCL~ROTIC CARD~OV~.S DI S ~ cu.f! En4K W~pERlY1NG OUE W ~OR AS A OOMS~QVEN(.'E OF} ~j. 3 - GWSE(Utenea'v+pry i . ,,~~4' _ ;",'~ua„~"'q sd~d,, ~~r ~ INTER2ROCHAI+~TERiC FRACTITRE IGflT I - ' r. . _ ~ f; _ a,e to~«+ ~s ~ ca+scoctE?:ef o~ ~r a,' fJ : it C~.. t ~ `f"~`~' e S~.-:.tl~-'' ?.r,s~j ~'I•,. • ~ _ PART M_ 01he~ s~gNwCaN tonQ~tiMa cortr~pestMQ b 6eaU ~vt nd ns~fi~ng tr+ the Yis _ YriLS ~1lJ Ml iOPSY ??b C1~ERE IW IQPSY FMD1N05 2s CASE RE PORi EO ~ S~ uwe'e.iyir~g ra~ne 94+~ in Fart f ov PERFOAMEO~ AWQABIE VR+OR iQ COMVLE iION ~ MEO~GAI ~ AORT~C ~NSUFFiCIENtCY AND METRAL (~uhbj QFC/SVSFOF~laH7MawNo) a' ~p~ it~GURGITATIOfV ~ N . ~ ~z 4S 1F FEbtAI£. NOIS 7HEFE R 30a IF $()qpEM ~3 ~E?dlq4fFDi1i PARi J or ~ EIIIER LO[IO[SlONfQi7 VVMCt/1T 1'YAS ~O 30b OATE OF SURGERY !Nn Oey ~4e~) , P~E(3tM~JZY MI 1NE PRST 3iAOtitlt5?C;vfS t~lK~ ~i ~i ' 3) FR08ABtE J~AANMF_R pF J2a DAiE OF ULK)sir J2tr T1uE OF 32C. RiA1RV AT YuORK'/ 32d. DESCRiBE NQW IKJUAY CCCt1AaE0 ? ~ ~ DE~IiH . !1?lanR; Qa1; 1larl i1J.lt1RY (lfiaer Hol ~ ~.,y~~.,~„~,,,,,,,,,~,~a JAtdURAY 11, FEI.L WRILE CE+RRYiNG OUT TRASH ~„~.,~a 1990 4 s 30 A'~ iVt) 6~ ~lE. ~ ~ rr. o~~ oc rrv.n,a,r k ew~,~.. an,,. ~c ioc.?,~on Fs+'..r.~e re.~ov aass~ ~ M.~ : car w t~..,,. s~a~e, _ - - - - cnse+. txto~..oe t~~f7 ACGIDENT AT HOME 30U9 SOVfHEASE OVF~tBR00K DR. , PORT SAII3T LUGIE, a.~1 FLORIDA j 'ir, ¢~:_s Eaworx> ~ ~ : ~~~~75 QA~~~ ~ ~ ; ~ ~ ; ~ THiS tS CERTfFtED TFsUE AND COHRECT COPY OF TFIE .E?fftClAt RECOqD QN flkE fN;7H1$ OFFICE ~ ~-~~ae sr,~ ~ , F;~ ~ w'~~, I t'~~-'~t:~ 4~:, ~ x. ? ~ ~ ~ BY: OL}Y£R H. 800RDE ~ ' ~ State Aegisuar ~ - ! ~ ~ Ah NEP QF TtSS DOCUUEld4 {5 PROtlS1TFD pT l~W. 00 NOI ACCEPT ~ ~~a~~t~G• SECefRITY PAPEA WIIH COLGRED Bt.CKQROLl.fl AN06qlDE7~9~".~59EDG%+EAT SEAL Of THt STATE OF iLCRIISlt. ALTE1S/4T[4N ~R EAilSURE vQ.u ~i:5 ;Fwri:~ClTt~.AI. or~x~+a.o ~ „t{~ ~S FGRN ~14A ~8-38; _ 41'/Tr ~ ' _ - . ~r~eanwrn2 eeef.~a _ ~ !v . . . . . _ _ ~ . ~ ~ • • • ~ ~ ~ ~