Storbeck, Lelia Eunice
jr-l
.--
.' STATE BOARD OF HEALTH
BUREAU OF VITkL6TATISTICS
CERTIFICATE OF DEATH
FLORIDA
STATE FILE. NO..---
Pinti1as
b. CITY. TOWN. OR LOCH ION
REGISTRAR'S NO,
91l'lTH NO,
1. PLACE Of' DEATH
a. COUNTY
2. UScUAL R[51 DENCE ( n"'.Il""C" dtCKU,d lir,i If ,.....'..''''"''': .R(l.ud~c. b"f~. adJO\u,':O'..)
a. STATE b, COUNTY
Lar-:-o
d. NAME OF (If not ill ho'pilal. girt ,Irul add"..)
r;OSPITAL OR
INSTITUTION Suneoast Osteo'Oathic Hos'Oi tal
Clearwater
d. STREET ADDRESS
.Ptne11az
t. IS RESIDfNCE
IN51CE CITY UM I rS7
YEslZ NOD
Elorida
t. CITY; TOWN. OR LOCATION
1495 - South Greenwood Avenue
Fi,,1
Lrul
lofonlh
Dnv
}'rar
3. NAME Of'
DECEASED
(TVpt or print)
5. SEX
..\fiJdlt
4, DATE
OF
DEATH Dee e1"1ber
9, AGE (/n-vtll"
July 2!J 1918 1a.'49Ihdav) ,'I...,..
BIRTHPLACE (Slnlt or fartl;n tounlrv)
.\1,...,
6 co.OR OR RACE
Eunice Storbeck
MARRIED ~ NEVER MARRIED 0 8, DATE OF BIRTH
Female
1,.fni t e
WIDOWED 0 DIVORCED
lOll, >11"0 OF BUSINESSOR INDUSTRY II.
12. CITlZ!N Of WHAT COUNrRYJ
lOa, USUAL OCCUPATION: Gir' killd 0,1 'rork do",
during mOlt 01 u."rkinV' il;l. {('in il rttirfdJ
Home::,..:. k~r
13. FATHER'S NAME
Orm Home
Dunne11on, Florida
14, MOTHER'S MAIDElI NAME
U.S.A..
Robinson Irene (unkno~m)
16, SOCIAL SECURITY /;0, 17 ',lNf"O,RMANT'i "aNAT?~ / #' Addr", 1u95 - South~ Gre~mTood
258-20-3832 yj(..h,;~~~hJ 0""~h....{:... C1enrHatEr Florlda
I! l:AUi[ ot D.tATK [<-'"I", onlv o,nt co,.,,', P<lli;,'i!:r (0,/';1." 1>,)' ,~lId.)l) , ' ,,' /}, " ' " ,
'''''~''':~::'~;:';:"::'''?~jJLrcv~~:rT ~ u~ ..
c~n,1'llon'. 'fonr'l DUE, 10 (b) /~$lld-'~,f-..0~U L~---L#cD:?2~-~-~
:~~rt, g:;,~..;I.I[a): ~-/-v .
,toling tilt U lido..
IVillg (II1lJ. la,/' DUE TO (C) --.L-c u
PART II OTH[A SIGNIFICANT CONOITlO,'S CONTR'aUTlNG TO DEArH BUT Nor RE\.ATl:D TO THE Tl:RMINAL DISF.ASE CONDITION GIVEN IN PART I(a)
Avenu e
INTERVAL BETweEN,
ONSET ANQ. DEATH
:,?~L_'-__
, WAS AUTOPSY
PERFORMED'
YES 0 NO gg
ZOa, ll"roO.bl1)
ACCIDE N T
o
SUICIDE
o
20c TIME OF Hallr .\fon/h, noV. )'tar
INJURY o. m.
p. m.
..Qd, INJURY OCCURRED
:~~Li AT 0 ~~:'~~~LE 0
CITY, TOWN, OR LOCATION
COUNTY
STATE
o1nd la~t .saw ;:,%.. alive on
23J LOCATION (eiIV. lou'n. or tOll,IV)
(Slalt;
Pinc11as Countv
26. REGISTRAR'S SIGNATURE
g~~ cEo
1 hereby certify that this is a true and correct copy of a certificate
on file in the Office of the Local Registrar of Vital Statistics of the
Pinellas County Health Department, St. Pe~rsburg, Florida.
July 10, 1968 ~{...'d; 6 E-e"4::k.,Deputy Local Registrar
/