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1 hareby cert~fY thls M b~ a tn~e and oorrsct o~py of tfie local r~ f.`~ 'QFT~
Reg+strar's record on fife in the St. tixie Ccunty Health Dcpart- ~'S'*.
ment et Feh P'erce, Fior~d~. ~r.,~;C~' ~ f(.:~.
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Cavnty Heaith Departmant is aff~.:a.~.)
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F+~E yp RECORDED
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