Ryan, Gertrude Marie
.
CERTIFICATE OF bEA TH
FLORIDA
,OCAl flU HO,
O"UOIN1-'!otMI
RYAN
O"ll Of OEA-1H I 'h., D".. }. I
1.
fiRST
,?ERTRynE
MIDDU
NARIE
LAST
'.4.CI--e.g_. WI"".. Ilock.
Am. '"d'\7l-tllfE'<il1/
.,
CI'Y. lOWN OR LOCATION OF DEATH
SEfJIINOLE
UNOU 1 YEAR
-- MOs~-OAYS-
Sb 1
J May 11, 1980
OA.T[ Of Br"H ft/.... IJ'H. t",.)
NOV 15,1904
.
710,
HOSPIT....l 01 OTHER INSTITUTION-No"... "'.IH." 1',111",. '11'1' ",#,,., .",4 ".....IIf."
10200, 122nd AVENUE NORTH # 3252.
7,
IF HOSP OR l"-'ST. lInd.eOlt D
OP/Errorr Il.m. l"'po',e'" !,"r'r"
]d
,.
STATE Of BIRTH (1/.01..
KANS'A13'-"'Y/
CITIZEN OF WHAT (OUNTRY MAR.RIEO. NEVU MAUlED,
USA WIOOWU':fr:leNO (5,.../>/
.. 10
SURVIVING SJtOUSE 01 ."1/1'. ,i,",. ..,.'~f''' _..rJ
11.
'.. FLORIDA.
"b PINELLAS
LA.HGO
KIND OF BUSINESS OR: INDUSJRY
SOCIAL SECUIl'IlY NUMBEI
". 488-32-8689
130
USUAL OCCUPATION (L'u-,. li,,4., ..r..l ~o,,, J.,i",
..OJ( of .-".1,.., li/r, rrl'lI it I"tirH)
HOUSEWIFE
RESIOfNCE-S1Af(
COUNTY
CITY. TOWN OR lOC.... TlON
'"
"d 10200,
I..
INSIOE Cll'" LIMITS
I~,,"cd, rO'...r \,,/
NO
FATHER NA.ME
FIIST
MIODlI
LAST
f-liSt'
MIODLE
15.
WILLIAM
H
RIEFEN
"'AIl1l't)bO:'4th
17b
GEllTRUDE
STREM~"~' VO!ARGO FTh~':i&
SHOPFS
33542'AII
'7.
INFORM"'NT NAME (1r," f" "'.I&,j
GlADYS A SARNE
~lnUAl. CREMATION. 'EMOVAl. OTHER fS"ci/r)
lOCATION
CITY Oi TOWN
STAT[
HEST COAST
",
CLEARWATER
FLORIDA
FUNERAL HOME
ADDRESS
lOb,
NEPI'UNE
13715-A, 49th ST N, ST PETEHSBURG
FLA
Z
.t~
u
..-
.!:
.!l...
fa "i
uZO
JE
..
~.
u
($Ignatu,. ItftCI Tllte) ~
:" SIC;NIO 01... D.., '../ "=.J:U' OF 0lA1H
NA.ME OF ATTENDING PHYSICIAN IF OTHER THAN CERTIFIER tT"" ., ,'UlI)
:ilIa. 0., thl' bo,... of CO.O....",.....,. ondior .nveu'go',on. ,n my op,n,ol'l dl'\J1k ()((v"td Of Ihl!' ",.,
- do'~ ond plOCI' Clnd,.d've t lhe covlell' .'0'1") . r -
(Slgn"u,".od T"Io, ~' _ =~ C u/ ~'--r"-('",-_/ >1..t!._
OAT( SIGNED ,,,.... v.., . HOUfl OF DEATH
..
.::
z
:i
-i.:l
! :
uc
J~
.!i
__ "d, ON~JLl2_80
21b
PRONOUNCED DEAD' \1.,.. nfl', 1,.1
5:- -=-L~__-'S9_2"UnkDQ\in_-=-__
PRONOUNCED DEAD (Hou' I
M
2Qd,
21,. AT
2:15 P.
M
N....ME AND ADDRESS OF CERTIFIER (PHYSICI....N. MEDICAL EXAMINERI (1",,,, "j,lt)
n Joan E. Wood, M.D.
'4. IMMEDI....TE CAUSE
(1:,"tTER O.\.Ll o...c (:.4
Exam.
260 Ulmerton Rd. W.
DATE RECEIVED AV RE:GISTRAIl: "10., DO'~. 1~~
MAY 14,1980
I:EGtSTRAR
u-~~
2Jb.
230. (5"_1.") ~
I'n,ervol between onu! and deo
'AI' 101
I
DUE TO. OR AS A CONSEOUENCE OF.
Occlusive coronary artery disease
Ye.ars..._____
{
,'nterval between onlel ond deo
lbl
DUE TO. OR -'S A CON5EOUfNCE OF:
Ilnlerval betwl'." O"Iel and de(!'
I
I
AUTOPSY (~'iI'O't:ilr ~A.S CASE REF~Ii1UD TO MEO~CAI~---
,u or rlo) [X....MINER (Sp~cily }'u or No)
ES
I"
,AIT OTHER SIGNIFICANT CONDlTlONS--Conditions (ontribulin.v to deot~ but not relOled Ie cou.. gl....n in PART I (aJ
II
27..
2S NO
IProbably) ACCIDENT. SUICIDE Or
HOMICIDE; 0' UNDETEIMINED (SI'#'Ci/Y)
270.
INJURY AT WORK (S,tc.fy r"
or Nor
DATE OF I~URY ()I D.. DG,. )".l
DESCRIBE HOW INJURY OCCUIltED
nb.
27d,
STOHT OR R.F ,0, No,
CITY OR TOWN
STAT
A CERTIFIED COPY MUST CARRY THE EMBOSSED SEAL OF THE REGISTRAR OF VITAL STATISTICS.
I 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 .::''YJ Health Departm21t, St. Petersburg, Florida.
May 14, 1980~ ~4~ , Deputy Local Registrar