Death CertificateOFFICE of VITAL STATISTICS
CERTIFIED COPY
rypNTIN
PCERTIFICATE OF DEATH
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3r_ INSE)E CRY
ERWIN
R. SFIEKER Male
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3. DATE OF DEATH lAlerrN,F
4. SOCUL SEClS1T1Y NUMBEfl
Sa. AGEi.at PYtldry
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JULY 6, 199
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S. WAS DECEDENT EVEN IN U.S.
JULY 25, 19
Sleepy Eye, Minnesota
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MOTHER'S NAME rf»[ Af'✓A, A41Mn S,Anrrs/
Herman Spieker
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K CRY, TOWN, ON LOCATIDN OF DEATH
Be. COUNry OF DEATH
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Brooksville Regional Hospital
Brooksville
Hernando
104. DECEOEM'S USUAL OCCUPATION
104. END OF BUSINESSANOUSTNY
11. MARITAL STATUSAea,Nu,
12. SURVIVING SPOUSE rtl ni/e, qve nwWn rrrwl
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Salesman
Manufacturing
NM MrAySP YA3owwE,
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bIFIBER
Brewer Mem. Funeral Homes, Inc.
3375
Married
Lorraine Curry
3.
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13a. RESIDENCE -STATE134.
COUNTY
13c. CT'. TOWN, OR LOCATOR 13D. SWEET AID NINANFR
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Flnrida
Hernando Sorina Hill 2624 Roval Ridae Drive
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131. I CODE
14. WAS DECEDENT OF HISPANIC d11NRUN OIIDIN7
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18. DECEDENTS EDUCATION
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NO
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White
17. FATHER'S NAME OwFLAMEN, laU
MOTHER'S NAME rf»[ Af'✓A, A41Mn S,Anrrs/
Herman Spieker
Louie Semrau
lea. INFOM.IANT'S NAME fTPp✓RinU
1NA MAEINO ADDRESS RbRtaM FApn4v «FL.' Rwb AlA1101% City «i wry Sl lip CeMl
Lorraine Spieker
2624 Royal Ridge Dr., Spring Hill, Florida 34606
-� 20a. METHOD OF DISPOSITION
204. RACE OF DISPOSITION I a <9maWv. «Fm.4»'. «
20e. LOCATNIN - City o, Town Stan
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Brooksville
_oNaon _Dm. rsrom
Brewer Crematory
Florida
21s SIGNATURE
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21c. NAME AMD ADDRESS Ofuner
SICE
bIFIBER
Brewer Mem. Funeral Homes, Inc.
3375
4420 Commercial Way, Spring Hill, F1.3461
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2 DATE SIGNED /AFa., f Y'
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23<. HOUR OF DEATH
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g C 22E. NAME OF ATTENDING PHYSX:MN IF OTHER THAN CEIIfIFEH ff p «Rip
23E. MEDX A EXAMINER'S CASE f
24. NAME AID ADDRESS OF 4 I IKn ITTarvNn..W- -1 w -
Jose Augustine, M.D. 14555 Cortez Blvd. Suite 1 Brooksville, Fl. 34613
THIS IS A CERTIFIED TRUE AND CORRECT COPY OF THE OFFICIAL RECORD ON FILE IN THIS OFFICE
!
JUL 1 1 19%
BY State Registrar
I
�ATRe
,A/ ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY LAW. DO NOT ACCEPT
rrARNINGUNLESS OM SECURITY PAPER WITH,tINES AND SECURITY WATERMARK ON BACK 6861414 . AND COLORED BACKGROUND AND GOLD EMBOSSED GREAT SEAL OF THE STATE OF
FLORIDA ON FRONT. ALTERATION OR ERASURE VOIDS THIS CERTIFICATION.