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~ a. fsi s iur[~ s swu ~~n t~ ~ a y1Tf IIECO. ~t LOGK IIEG I~ECIST~~R3 SIC11~
~ Milt~n Mi. Baird Ft. Pierce, Pla. 1 U-$-6~? Mna l.ee ~enison, d. r.
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~ ~ hefeby oertify this to kx a ~rue and oorrect oopy of the Loca1 F I L D l. ~•J D R E 0 R D~ D K
~ Registrara rccord on ~:;e i:: the St. lucie County Heatth Depert_ '"'OM~
~ ment at fort Pierce, Fio: =d~.
~ (VNaming: P:ot v~:id unless ra;sed seal of the St. lucie ~ •
~ County Heatth Department n a~iXed.) '~o ~~1,~'iR 21 Pti i. 48
~ .sJ
N. D. M1LlER, M. D. R 0 G t: L E i~ K
, .
~ , Count~ Health Officer a I.ocal Registrar . ST. LU C~~ C~:: U P: T Y.
~Q ~ j~~`K ' ~ FLORIDA
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~ ~ Orputy Loul Rpistrar p~~~
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