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HomeMy WebLinkAbout0156 . _ _ _ . # . _ . . . . . _ _ ~ ~ ~ _ ~ i ~ ` B? II~YIDUAL ' , STAT~ Oa' ~ Oppl~l"r ~ ~ 5$.: I f ~ t• I10ti1'~ PliDli~ $1i~J q1ii~.~"1~ ~1 ~d ~O~t M1d Ca~m t.~ ~ bY that On thi# ~ ~ - 19~.,,,~. ( pLce ) ia d Couat~, ~l~ar~~M ' ± =P~'~d ~ !g M w ~ and to arat p~s~sas $ ~ P~`t7 to and ~o e~cutrd ia his o~ra parop~r ~n~a~it~ +Rad wh~oM au~ ia w~- - ; abrib~d to tbar witbia wd twre~aing a~?d az~ac~d inst.~wrrnt oi vri.tins b+~ria~ dat.~r ~ur i t~ar~in l~adia?t~d, ~ad p~o~a~d a~nd d~lf ~er~d the e~ b~ fore N asd v~ • a~on Mini ~ iiurst 8~~ wrera b~r M, ~tst~d that ha lmore the coatents ot said iastsv~at and ~ _ ~ladded t3ur?t l~t ai~erd* eea).ad, executed and deliv~red the we sut and to b~ Ma ~ !'~t~r~, Iwt~l aad ~oltmtat~ aat aad desd for the usss, purpoaes aad co~aai~eration t~ltere- ~ i~a iratian~d an~d contained a~nd eert forth. ~ t~'lwn uader uid vritaess ~ ~ my haad aad oiiicial seal the da~? and ~Mar in this ~ certiiicate firat wbove ~tten. G 4 - , V \ ~,t' y t~^lr~~ . [ ~~~1~'~~~ ~~1Ni i Y~MM~Y ~ ~ _ ~totat~ Pablic in aad for ta.c..:~. Couaty, Sta~q,~ . l e''~~ i•- - Beddin6 at o t l • ~ - • ~ '~t~oa ~ s~ d'~'ogi° ~ ~ , - . 3 ~ ~MISSION EJIP~RES rEC_ ~6. 1966 - ~ ~f. f ~ = ~7tc rr~r . _ i t ~r@R~ - ' ~t`~,~~.: - ~ f r ~ . ~ ~`a~a 969 ~Ackuowled~eent to Form 96~-lE.A.]t.I. ) ~ . ' i ~ st~SDQLE nA~ S [ William F. Carter, M.D. ~ 1145 Ri.dgewood Dri.ve Augusta, Georgia ~ ' W ~7~?i'~ ~~F~Or~RiflA ~ . t~ QOK3UMEtdTAo" STAMP TAX . r 1 4013 Sofa Pattern F~clid ~ a, r~~Q ~ ~ ~~ER I I 8 5= , : ~ 3 2931 Chairs Pattern Euclid P.&~fo~a~ . S 3 ~+?31 Chairs Pattern ~clid : ~ i 29'j20 Table ~ - ~ 1 ~t 930 Woodcraft foot table , ~ 1 1450L File - ~ ~ FIL jV EC RDEb 1 11545 Harter Chair ~ n~ ~~~-~Q~9 0 0 K ~ < 1 3569FF ~7esk ~ z ~~~u~ ~ ~ 1 5i+3 Sr+ivel Chair '6~ ~3 ~ ~ ~ ~ . ; ~ 1 54p Side Chair 1_~s~~~t~~",~ ~ . , j ~ 1 VHI Dressing Cubicle f~ ~r r LE c~ K ~ 1 TF 930 Cabinet ~ S~•_~~:ClE CGUNTY., I ~ '~FL~?R1DA~ ` 1 TF 950 Operators Stool i $ 1 ~ ~-6140 Hearglabinometer ; . ` ~ h~i~+i., f. 1 ME-2~54 Nat. Caatery . , ' 1 ~'F'-4450 PY:ysicians Scales , ~ ~ ' ! 1 0~-'7022 ~le~tric Sterilizer - r ~ ' ' ~ ~ 1 8E-2025 Bauaianometer . ~ ' - ~ . • - ~ ~ i EPi~ ~ _ _ ~ v~~ ~ ',~fi.ll am . Carter, M.D. ' ~ f ' y t e ~ey A ( / /1 1 t / ~ + ~ r ~ ~ ` - , - 0 R i > BOOK~~t ~JoAnn~ i~. Cart~r eJ . _ ~ ~ , Dated ~r - ~ ~ ~._..r........~