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_ - _ -_;,T.ri3.6e CIPrk of thr Circuit Court oI -
YAYL O~COUNTI' NAYL
p(..L.+,.~~ b[t.x¢ f c'Q 1«tk .. 1>nrn at Ct.~R•,,ti. ~, r .~f~ ~`~rti. on the <~•`--(
AnnKr:. ('
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day of 1ti1c>,1c+. 1`13:1 ,graduated at ~,t5vQ,1~ z~,~t..~ta-,.~-7 date x~v~ I t I ~_
nr:~T.,r r,~r.t.ece (;
who, heiug dull' sworn, says, I am the person named in the foregui•,g license and the person namecl in the diploma which I dis-
plavcd before the Florida State board of Dental Examiners, and am the lawful possessor of same. 1 have, hefu)e. rrceiving this
lirrn.r, r,vnnlied with all the requirements to the examination required h}~ law: that no nx~ney has Ik~rn paid for ~orh license,
except thr- regular fre paid h)' all applicants, and that no fraud, mi+tepresentation, or mistake in any matrrial rrgard ,ras
emplined by anv onr•, nr occ,:rred in order that such license should l,e granted.
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Signed `_ /Y~ ~;+~ - F3'., ~(!" ` `~-`~"'-----..n(,'~'S .
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ST.\T F. OF fix. C-u --L N _
Signed and sworn to l,efore me this ~' day of `'------ ------ ----, 19 ~.~•
, SiP„ature of Officer ~L.-L-~'!'= - ~
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~~TA'T5 OF' FI.Of11DA 1
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COUNTY OF./.~~~~? ~--- - ..- J}
ourt
_ - I, _ .,~---~~<<-=a---.ll ~.l!i <..'- .- - .--_-_ ,Clerk of the Cin~uit C
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in and for said County, do certify lhat_ _~ : ":r,-t.-.- - - - "~-. -`~ ~~+
of -_.___t~ct : ~L a. has this day registered t})e foregoing
License and Affidavit in my office. ,
WI•CNE:SS: my hand and LIJ4 Beal of paid Circuit Court at
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Cler>` of Cirzuit Court.
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o~ o ~ De uty Clerk.
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R'~cxt#d In Ofitelel RecarA Soak
pf Palm f3mcYi County. Flonda
J. ALEX ARNETTE
CLERK OF CIRCUIT COUR?
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