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Falconio, Dominick J .. F=\PR-12-93 '! MON 10 13 Rhodes. Dru d 813443-0253 P.02 OJ/II.C'';'IM PilI 86267920 I Mto1eO FQRtoII . D.R. 6 3 5 8 mE 1 ~ 81 TIlls i\lllil.tlaim Jltld, P."~t"'fJ 1'". 3rd. 601.1 LIDrd J. ralcord.o , November . A. D. 10 86 . II; Marie Hirst - ['r.' parl1. '0 Donlinick ~ WIIO,W'I,;lvJ/ICfe,tlrl'(l1II. 1324 Bar~y Bt.. Clcnrwlltot', F 1. 33516 'lINIml parl)/: 1a)'l'tf1'1N , t.1~ ~ l~~;'::r1=.' :-df~.I~:' ~.~~;:~~~:"~ ~r.loh:~r.:.:" ~ '~'~~~r.il~:,.~..!'.I~~. ,t"::':'::: .. ",..I.. .. ""l.~ru.1 Splloca 11, Lo'b 20 - Dlook 12 C10lU'\m'bor Cometary \4 1~l)li tl!r 7. 7a If 0 'II TOTAL : 'Witnt$$tlh, T/'ClII~(t MId /Ir.' pIII'I,. Jot jll '1""" /lolcl'.)' "1/1 "drl .-coHd parl1. rho "'<<"pi /(101/1 alld /(1111 .:1"'"1 lI,do 1/'0 1.,clICIOCflld par', /0 ./'0 lolel/lr,' parl)l 11d1 In olld 10 tI,. Ir>Ilvwl.." dOl In "ll COIIIII, 01 P inollu '/1 C'tllltclrrallon ., 1/," '11M 01 $ 1.00 . Itrou/., 'lrrl'b, acAllou.I.../opd. dotl "r,..~, toml,o, ,.. Ullr. all II". rI/J"'. 11/10. 1111".,.. .-101m "lid a~III""J w'.'.;" b..J 10', pl~tfI or ppr~"" "I 14I/1J. ,II'U1/0, 1)I'no /l/.J ~t'I' Shall' ~ P10l';icla . 'GlUlI. 1 Ctltlt\~' ~ o .: 010 RoC ...0.. 41 OS " 4:Jlnt- ---.. Tot :b~lt\ ,~... 't.. 1'C, , --", p~ ~1l'1."i""r IS..,o('.1( t.. . ,..,,'u'"',..........,;tj... "1'1II:"" "" ri~lrlL~ f. ~ _ l.l~II'-\l1 U~11 ..,..1)>>. 'l t . 12N08A 1,00 O,Slt 5.S9 CA3H . ?"= ~;:: 'c *; r. -. .. ~. . . - N' . " ~ .....j .oO .,! ~. ,..., r . I ~ .,' ~ to' , . ..~ . " i ~ ..~ !t~ S. I~! f: !To Jlalll and to ltiJld ",0 "'." 1011 b.>l'I"GI"D Clr In "11111'/1' il/)IIf1""I,.lng. ami 011 I~ 'Or'llor a[ II'd ,p/J Ilnl pa11~. ,1I'.1lI' In law or "11111 10cOII rl po"y I_IIr. :1111lllillttS$ 'bfhmiJf, Th. ,,116 I'r., /)nrl I.., "lIIIM IlIId "'n'~J 1'lrS" "...,..,. II., Jay 11",1 )poar Ilrd a/,ova 1./"11I.,,,. .3;;:~~.~;L...... f2a.....J!:...~............. ......................u.................._................................... J~.,~~,A;.......u. } ,.., 11I11" all .nil ,'n""I,.. ".. OI'Pllrl"".'I~1II I~..rounla .,101,. ""hl. lilt.. 1111_1. If".. ",uI/7 QIUI ,'oln' ",',nl, t" I,", ",.1)' P'lIp,r 1./". 6,.1\,[11 Ilna ""~~I ,,/I'1ff .,,111 n'A 1'& OF Ft.I]1QDA: ('0'" . \ COUN'l'V OF ~..~...., I I HERIlBY C&R TIFf .ha. 01\ Ihll dft,.. belotr lilt. III vllI." dlllr aUlhorl=rd In Ih, $Ia~, 1lI0rclllld AI\d ill I.. Crnll' .rartuld III ,ale If\nO'o'kcl&lIltnu. peno....nr .Plll'lol'c!d \'f\~\.... \\."I\~" "'-<4~ " nie hll"lft '0 h Ih. "",- ckw;ribt4 IIlllld ~ clUfu.rd I'" lorr,al,. 1.,uulYI\'nl ,.4 " ar.~llo..lr.I.C11 ~~~ ~~~-, '~ WJ'I'N':SI Ill' h.nd ,nd oftlfl,1 Ital In Ih. (lau I, ."d~' 1.l~".'rI'ld 1101. , .. l!~;;l. melt}' III ~~"...", \.'A.- A. P. ,,'<<.. , ~.. (\.., '~'~\"\S\M , .......".".. ~,,!;. t)' ..... .."~.l..!..,,d:pl~ ....... ~::::f " ,.. ". "'./ f :' J J"'.." .' , j :~... ; ~) ". tl'oltry Pllbllc. s;1~ 01 '1ot1\Jjl At \.0(11' 1'1;1 Comml$~On ~I'O. M.,. 19. 19811 'lN1J l1tsJnlmml fl""jlfImI &,.. 1l.11d. rotum to A"",'n1 Dom1nl.ck Faleonio 1324 DGrry at~Qot C1CArw~tor, Fl. 3'S16 ~PR~1~-93IMON 10:15 Rhodes Druid 613443-0253 P.01 . I . i PAM~Y MEMBERS Please list slJl'vlvlng spouse. children, parents, grandparents, brothers Bnd sisters and their cities or residence. Show Lila number or il'snclchildren, great grandchildren, etc. RELA'rION NAME CITY S'r A 1'S ~ct-.J ~~L-~~l~ _ 3 bbrV' ",.--.lLs. A A I L~:ntA-M ~'E.J.I..S..E-.bJ_~. 5'1:0 LA~ T-,~J;'I,..C.Dt-J1 t:> ~' -SLc-:~ x.& _J:~ ~ (3b",! ~l) A..." C I CD ~c ~ ~~~.-go- CD ;C ~ --, ~-- J.:A, I .-*=:~ SWji, H ,C b~~l~ ~' ,,~_.l~u. _. . ~~~'-I -W be.- ~\s,t.j~ ,A.JJD \.~ -~.-uJ O\:s~ l Qr,"Q ,-n -'(?n;:!Qg;~JI,._M^e"cp. ~); SE~~r;; EtKl~%P 11;. C01S'(O /1/1. A.o - -I-:-' I? M.;J;M ~, TYPE OF FIN~ Ni-PQSJ.XION: CJOLu:.-'wuu.AJA..j ce'{r\.C.., 7 ~ Local Burial~~re,"ation nntomlcel IJonation Recelvlpg . ~~ .,(./,.-'./1'("" r" 11:-1 SEll,: ',JbJ(]t )'1/f., ed,J'"i isit . No VIsItation No Service ,...,,-..-.. ra 1 10nal Servl In Chapel Graveside A .. _ , emor f Service In Chapel At Church ~ . &(UIJt~ ~' ''-J '\,) C""P"rorJ ~<:. ~ C!. ~/.\-I2.WA ~ I r= JJ ~~VJ\"~ y~1J. (..~ ~ ~ '__..r.1W ~~::&fl'" aUtfA,ttafiC -; CHA RGES: Professional Servi<:es or Funeral Director c5c Starf Cat'e or tl'he Deceased Use Or'l'he Facilities ~- Autornotiv Equ\.prnenC-- Casket E.o YO ' Vault Shlpplni Container Urn -. Other Cash DTsburseri\eiits_ , T---~ ~ . I 'rOTAL CHARCES j 'rHEABOVEQUO'fA'rlON IS BASED ON ~UR CURRENT FEE SCHEDUJ..E AND IS SllBJBC'r TO CHANGE 90 DAYS APTE_R trODAY'S DA1'B, UN,LESS PREPAID'}. SIGNED DATE ' .I ~R~12-93MON 10:12 Rhodes Druid 813443-0253 J P.01 RHODES FUNERAl. DIRECTORS, INC~ 800 EAST DRUID ROAD , ~ CLEARWATER, FLORIDA , 34616 TEL: (813) 446..3055 Date: ,Aft it Jc1/(Cjg.3 Time: TO: FIRM: FAX II: FROM: FIRM: c.~L-~~ ClTt( C(~-Ris or/'/t'f: q (a :::J - ( I'J "7.:J c) ly\(.i 1\ 1 tJl.l.JYYJAN Rhodes EunAral rurAntors Inc. WE ARE TRANSMITTING , ~ PAGE(S) INCLUSIVE ~fL. ARE TRANSMITTING FROM FAX' (813) 443-0253 IF THERE ARE ANY PROBLEMS IN TRANSMISSION OR IF WE HAVE SENT TO YOU IN ERROR, PLEASE AOVISE. THANK YOU AND HAVE A GOOD DAY~ COMMENTS: --1i\,(~o J\J I 0 , 1u:cf\ 4- ,T<f'~(~(jt-:-.sT ~E: C~-mA1C'~ J!OYlI}/AJ..s "i ~ Rr~rTtr~D APR 1 2 1qO':l Ci it (U',~, ':.( .........,.'t.