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I hereby certify this t4 be a true and correct copy ~f the local
Registrar's record on file in tha St. Lucie County HealtFi Dtp+srt-
ment at Fort P:e~ca, Flor~Ji.
(YJorning: trot v~.:d un~ess raised seal of tho St. Lucie
County Heath C'eoa~lment is affixed)
SST, _tUCiE C~UNTr. FLA.
a. R. 4~ PAGE371
80~~K
N. D. tllill~R, A4. 0.
' ` J ~ bounty Health Off:cQr & local Registrar -
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~ pepuTy` Local Registrar (~ • r
_ _ ~. ~~~
ST. LUCIE C~I~NTY• F! A.
~~.~, 8~
f11,ED ANG R~~ORDED : ~ ~ :... .
iN _~...R,eco~r~.B00K ~'' ~.~~ ~ ~ .
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1961 t~OV ,7 AM 9:47 ~ ' ' `' :: .
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ROGER Pt1iTRAS, CLERK ~~'~~:.~~~~~~~~, .
ST. LI1C~E ~OUNTT, FLORIDA ~: ,~~,;':~;;;.
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