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HomeMy WebLinkAbout1643 ~~z ~o . L?rs fTAT! ~.:tC 01 MfALTl1 CERTIFI~~ OF DL~ATH ! l~~,, rT< ,-'~f ~~~~r - i ' ~•.1. ~ ~ ~~ta,v ax ~rrK ~~TNr~ '~at~t vet~ iii~. ~L~`~~D~l •ri t T i P'\~~ i/ /IS+If'!Y C~DO t IMU. M~11~? ~M[ 1#iw. Irw~•.~' rr.r t/ ~i.. lM+r w~ ~el~trv? sf•<v e~ aw"Tr gt, Iuel• 66-025 ~.~~TC Fl~rid~ s oo~rY :.e~.,cl~ s. r~-...~ f. cm. TbMI~. ctZ ~au~1011 c. ~s rlACi o~ o[an~ i c. c~t'r. tvwe~. 011 t.otATdl ~ n~~ e? MefrO[ Lw11T'ii ~ ~aL C~17 LM~T~e r,,, Ft.-.Pierc~ „0 1~'L.Pi,~rc~ ar~r~+.l ~ ' J ~ ~ s. ~r~ a? H wa ti 1w~rd, ~...r«r d.r~.,.i ~ uwsrn ar ST1iET ~DO~[ar ! OM ~ •nnste ~ITtlTIOk ~os.+T~? o~ Pisre~ l~~rie±~l 1~` Old L~xid R"y r 2 Hs~[ 1~ 1 ~ ~ 1 iM!![ M /Yr~f Alllli~ l.~M ' 0?f[ L~wr D+ X'M? MMA~i~ (TM~ ~ /r~i Q[AT11 _ rn fit CO104 011 R4Q 1 r~R~~EO q I~Y[R M~RRKD WTF OI MRYM w f~i 1/ 1 A . X.r. 1.w "+.-v Yr ' ' x ' • 14a1e ' w+noeEC nw~cw e~ ~ 1' IQ~ vSli~l OCC{Y~T~WC c OMv tiw/ ~wR M~r t01 K~o os iufwtl! oR Nlvv!'711~ t I ~M ~L..~~~' Y _ . • ~ '1 e T- ~vA~ nwt y wwtlw/ e/r, IJ .whd) c rr /w.1/. ew yr. ; vnaw ar w" ~rr esr~.t ~ ~ Y 1 ~+1 ~ S~k ./~7}~[~ S IMp[ 1 40TM(N S MAI~11 qAN( 4' ~ er t~r+~rte~r ~ -~~Y~I1hls 1 M~! D[CE~D IYE! NI U S. ~RU[D IOIICIS~ lOCYL 7[CUMiri IIp 17 MI/~~ t M~IM ~ ~ l'r. w ~ vJ~wJ 1 f~... w ~ M~r .r..r ~ ,~a~ A~ 1 A~If~ Y Mres*•; 1~ iA~M[ ~i MAfM ~rsMr ~w7Y ~wt t~fwe trr lf~r ir iA~. e~~ lr) ~ rfTiR"V iirnsc~r ~'~~T~ a~Tnw~SC~tri[D/~ ~1`e.moRA7M ..~4 ~++~ca~h c4~x i., ~jl~rtCAl11][tl_ CJ?2"d~lYttGU.1i1.~ diau~: c~• t l f f e a: e ~yyyy~,T p~ ~o f~) - - tb t 1~k# IAt r 4 - - - - - - - - - - - ~ - - . 1 t e= 1 ~Owr r~vu •l. S~t*ir N~Ny f1u ra4r~ ~ fpfw~ c~r~e ia~! OI.E ro (rl ~.s~f'~_ ~~'~.L-- . s t - , r ~ _ - - ~Le~#a~~.~,# r~=~4.t~__sl~~tse - - _ : ~ - \~rr e a f ?A~T I~ O'wE~ SK~riC.~n COivo~ria/ Ca~f'~qllTVi ~O OG~M ~U~ I~T ~1[tJIT[D iC M r[lrnult QQli[.~fY COw0~1'10~ C77Cr er ?Mt`~~,tl~-• l~ t s r d~ a t? . • J[+~ErON uKLi1 , ' ' ~ U ar ?r~nrr ~ ~ :~•i • • ¦ ~S: ~ ~ ~ ElC 0(~CR~~f ~eOw ~MJt1~~ GYCURKO ?rah+ ~rrrr al tw}sr/ i• P~•t~l ~ ti.1~ ' ~ J : . ACC1p[MT S'.:1{16( ~C+YiCIQ 11~~~~5- J : .i~• ad ~ - a;. a....__~_ _ j i'"- ~ ~ ~ . ~ - 2bd T~M[ 0~ /fwr Msw/A. Iht. Y~r , - ~ ~ralilR~ ~ r~ , r ~ ~ ~ '-i+t--- IMJUIIY OCC~,.~~tn mr Kat[ cf iK.7t~Ar r~ M~. ?ro.1 ~10~. t~T~ rOwM 0~ LOf~t~ciN COUpt'Y ST~7t ~Nilt AT qp~ ~Yw~IE (-1 /MfN, /~ffOr~, tl'rtA. ~~[f h7~~ . Idf.l • ' _ wOQK ~ ~i.b7~R _ , ' .~~('Lj•. . . • . 21 1 r~frnd~d ~1+~ d~c~~~~d/~om _ ~~.--1~~~---__ . to -----~nd IRrr ~,ar•'~ ~ron~~y:~.~__ W~th xcui•~d rr ; ~ ~~y~ ~n an tA~ d~te sMt~d ~po+~: •nd ro th~ D~~t W nr twrrl~wl~. /rom tM owu.w sl~twd ~ 1 1 : t ~ w • - - _2233~t~.__~ v~ _ - - sr t• 1• ~ Hi1MTVRS ((k~r~entM(e~ ~YSC ADOa[SS ~ 8~~8 Grsng• A~nnue ~T` s""° a I ~RSrr tlr Ma+.~ cau.~+rw 27n D~~E tY r~wt oi eirEr[~r r~n cRtN4ro~r `77t ~oe~tivp tc`irv, eww r awrt~~ (l~.u; ~ Q[~os+c i?yrn/~~ - - I r. t. t s t f te ~u~~~i~~ic~~ ~c ~ l~~Lltr ~ iS QiT[ MECD sr ioc.~-~ c ~~ccn~~ ~Osw~~y• ~tM a~~;~~,- ~•'.:°°a Ft.Pierce,Fla. q-1(3-.61, ~ An~nw l,re I~iaon d, , r. ~ hereby tsrtify this to be a tn~e and co~rect oc~y aF b qN D R E C ~ R 6 E Ci : Ra~istrer'a record on file in the St. lucie County H~alth t~ e B 0 0 K " mMt at ~ort Pierce, F!orfda. ~ ~ tVNarninc: ~l~t v~'~d ur~ess raised seal of tha St. lucie . ~ CouM i~;ea~rh ~e~srtment ~s affixsd.) ~M 3~ y ~ y ~ '65 AUG Z? ~~'/'`'~.~t ~ „ 'j< . . r N. D. MILI~R, M. D. ~ J . Count~r Heaith Officer ~ local R~Q~$~t ~ ~ ~ ~ ~ 1 ` N .J. C R K ~ , . ~ 57. L.UC? R QAUNTY. ~ ~ ~ ~ ~ ~ _ ' ~ , • p~ lotal Re~istror BGuK~~~