Death Certificate2124 Cottondale Ave Ie4W0 I —y" A.Iw
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Homemaker Own Home
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1R 0ECEDEMi EVERN
OFFICE of VITAL STATISTICS
M AEDMAL E4A.INERS CASE NUI6ER
CERTIFIED COPY
A
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UIE
FLORIDA CERTIFICATE OF DEATH
TLF xo.
0915SENUMBERrdO
ECEDENT6 NANIE (FM
_EMIXY36
—C~WroU.D.. OWPaq®lSPbwl.
rraine Spieker
_DLNurM.
Female
ATE a BIPTH rwa. a4 rewT
Weiner, M.D.
A4 AGEL4 Lea,Nr
AL. R 1 R 1 Ar
s. DALE a DFATx (Moral, ay, v.M
M>,>, �'� w urNw.
wember 6, 1918
r� u 86
April6, 2005
OCW SKURm' MI.MBER
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e. COUNTY OF DEATH
�t-07-2026
Chicago, Illinois
Hernando
LICE DF DEATH NOSPRAL
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FACAITY NAYS R7mf n.M,A-on. gAS MraN.0aea1
114 CItt. TOYIN, OR LOCAnON OP DEATH
fro. INSIDECITYLIMRS7
24 Cottondale Ave.
• Arlington
Spring Hill
—y. '&W
MMtRK STATUS (S.ofy)
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RESIDENCE - STATE
LOCATION-DITYORTDYa
em. COUNTY W 071r. TOWN. OR LOCATION
arida
Hernando Spring Hill
fTREFT IDORE55
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1MZIPCGDE 114g
INSIDE CRY LNITS'
2124 Cottondale Ave Ie4W0 I —y" A.Iw
Iso DECEDENTS USUM OCCUPATpN Prauro ryp W+w. abr aruirgnmd airwM�g M..) The KNDOFIWSWESSINOUSTRV
Homemaker Own Home
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TRE OF DEATH MM
M AEDMAL E4A.INERS CASE NUI6ER
m37
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�119h irCN WIro CiPbni
Xq, rrtgd a'ponl.wC#D
0915SENUMBERrdO
_EMIXY36
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—Assm4e—B4aNH. _WIMP
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—Y. JLt
• n FATHERS NAME (A f Y.}BA lat $NLv)
Weiner, M.D.
21. MOTHERS WALE fF & ARF9e, MNYn SLTAN.1
Patrick Curry
I Marion Newman
3NI. 2p FADE
22. IFOAl sHNE
ffiREIATONSNIPTODECEDENT
234 NFORNIANTS
ARNICA -VATS
- Ronald L. Spieker
DCAL REGS,RAR-
Son
Virginia
11,
234 CrNOR TORN
23P SmEET AOORESS
(/ 005(W.
M zF CODE
• Arlington
4845 A S. 28th Street
22206
- 2n PLACE OF DISPOSmDN (Nana>m+NWX wsnYo'y.aobrpam
ua LOCATION - STATE 264.
LOCATION-DITYORTDYa
Brooksville Crematory
Fkxida
Brooksville
zse METHOO of DaPosmoN _ Bua _ Er.IXrMN,Y A erslrm _ Dw9an _ RMIAM ram Mae _ D.1r rwvn
2® D :NEWI%Nr. DONATION OR SURAL AT SEA 01 UCENSE NTASER (d(Aaasl 374.8 RE OF FUNERAL SE(NICE UCE OR ERSON ACTING AS SUCH
WAS.F-DMgL EXNMIER
APPROVAL GMNTEDt 2L Yea Nn (F ya 70 ► rL Lti�
25. NAME OF FUNERAL FACRfTY 29L FACIUTYS HARING -STATE
Brewer & Sons Funeral Homes, SH Florida
294 ORY OR TOININ 29c. STREET ADDRESS284. 2A CDOE
Spring Hill 4450 Ct3mmeFcial Way 34606
b OERTIFIER XCMLIF'vIp PNVMd+n-ro ur eta>iIry 1A4+MCF.a.exlaWlae.trn me.ame ret gMu. ve a,.lL ua tsna(clr,o mr.a mba
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+ftzt&f"--0 APR 12 2005
L�WARNJNG:
ABOVE SIGNATURE CERTIFIES THAT THIS S A TRUE AND CORRECT COPY OF THEEOFFICIAL RECORD ON FILE IN TMS OFFICE.
THIS DOCUMENT LS PRINTED OR PHOTOCOPIED ON SECURITY PAPER WITH A WATERMARK OF THE GREAT
SEAL OF THE STATE OF FLORIDA ON THE FRONT. AND THE SACK CONTAINS SPECIAL UNES WITH TEXT 11L+L"1L
AND SEALS IN THERMOCHROMIC INK.
III II III IIIIII III I III II
........................._....._DOH FORM 1946 (02 N,
14164g6 •_ • •
a
4 9 6
(mrW13Ty)32
TRE OF DEATH MM
M AEDMAL E4A.INERS CASE NUI6ER
m37
1l NODI
0915SENUMBERrdO
r W/
3b. CERnF1ERSNMIEMitch
t37DATESSNED
Weiner, M.D.
3®. LRYDRTONNSTREET
ADDRESS
3NI. 2p FADE
Brooksville
12260 Cortez Blvd.
GS,RM-Sgnyway D
DCAL REGS,RAR-
pE34613
�.CA� Wy, Y)
11,
(/ 005(W.
+ftzt&f"--0 APR 12 2005
L�WARNJNG:
ABOVE SIGNATURE CERTIFIES THAT THIS S A TRUE AND CORRECT COPY OF THEEOFFICIAL RECORD ON FILE IN TMS OFFICE.
THIS DOCUMENT LS PRINTED OR PHOTOCOPIED ON SECURITY PAPER WITH A WATERMARK OF THE GREAT
SEAL OF THE STATE OF FLORIDA ON THE FRONT. AND THE SACK CONTAINS SPECIAL UNES WITH TEXT 11L+L"1L
AND SEALS IN THERMOCHROMIC INK.
III II III IIIIII III I III II
........................._....._DOH FORM 1946 (02 N,
14164g6 •_ • •
a
4 9 6