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. . ~,:..T_ . K~?.. :t CEflTit'ic.~a'~~:~ . c~~~a, : . ~ j4 ` DURiAI: 0:= fTATi=1::.~ .AT[ FiL[ NG. t•;~t fLOAIDA ~-J P•4?Y hC RLGItTMAR'f f17, ' ~:y;~~If •1 ~LAG[QfatAT~: GOD[ NO. 2 YfYAlAitlOtNC[C~faw.~.w...t.«t lf:+.wnr.w:t...:wa4/~.~/..w.wy. r:,tt~d a CO~w7Y l. STA:[ COUNT L~ .l~1 SrE~srd x X Fla. $revnrd J. ylu~d ~~t_ ~ C. C~Tr, TOMK. OR ?GC47~ON K K~G[ O~ Of~TM t. CIn. TONN.OR lOC4T~ON t. IS RES~DE`Kf I~l.:is:i River Cit ~NS~oc ~Tr ur~TS~ ua~~ F UM17S1 t,:,. Y rE J~,,,p Indian River City res3i;;•~•~00 f. ?~yE Os ~ayv~f. /irr ~tr~ct ~Ihual • IENGTK Of f. SSREET A0011ti5 ~t L ~t OF A •rAY~ NOSi7" _a t noae V~ S~~ 3~ • ~l STAY ~M ld u~ S HW • il YES ? ~ :AST.TVTWN • ¦ 3 K~r.[ OF /1'nf A~irfk Lwt t. D~Tf 1~Ia+u~ Dq Y~n T`,r`~,', p,;,,,~ Jeanette R. ARI~OLD ~°i„TM Jan. 5th, 19`)9 S SE7( 6 CMOai OR MCE ~ YARR~EO hEY[~ MA~w{[DQ i D~TC O/ ~1RTN I. ! ~Gf N+~~ s~'XZ ~ ~w wx~ 2t fiK. 7 r 1 L• ~ ~lr~ y~ ~ Yii WCi • 19~~} /Yf Oi/t1/~~) Xwr4 D~p Nwe~ Yiw. WIOOwED? WVORCEO ylafnl~ ltk~ lS6tiOCCl.~ATqr.Cictt~wlyrN~Q~~~ IOSKIMDOr~7S41FSSORIMWST~• 11 ~UITM?~~CE(S~ttw~rry~tM~~ta~) 12.ai~or.w~rcparcn~re . i t i~ y~ r- I~ru~ mat e/ ?atrn/ (~/t, ~erw iJ rtti?tb Z =aT•n~ house keo ar at !:ome Pensacola U.S.A. j:ack Ink 13 ~A7N:p S K~~E 1~ MOTNER-S YAtO(M NAYE " ! rch af'racden Lill:an Terryn ,~a cr,..r?c•r ~S ~~5 pECE~SEO E~L71 tw 17 S. I~PrEO fC11tES! 1~ ~IAL S(CUII~TY NO. 17 !MiORMAMT {~IOIMTYAf t Yr. w ~~lww~ t!/ w~. hw w. ~ 4Y~ wn~) ~ no no nona wu..., °~.,ne: ~I l~ CAVii Of O:ATN (~'tfn ed~ ~~t t~Wt jrs li~t fv (al, (D1. (tl.~ . IlfTtnYAt ORX•~ OhSEi AMD GE~Ya ~ _!r~etot ?~ATI 0(~TM1r~SCAUS[D~V~ ~ ~ywEOI~Tf UVlE (~1 acst :11• - - :A• e~r- f f c~ t• Cc~duioni. i/ p/. pyE TO ib) s 1 th tA• r?id ~ur r~K q~ - ' : o e• 1 eAxt c~ru (il. ~~I r• lstr~r dcie~ f~ r~1er- - - L = l~~~/ ca~re 1o~t a+E 70 (e) ~ r f[:1 w: ~ ~ ?A11T 11. GiwEll SK~~CwMi CONpiqNi COMtU~{lTI~G 10 D[ATw R1f NOT IIMt[D TO TK fFllMYW pSUf[ CppT10M GIY[M 111 /MT t(~l . W~S AUTOrSY I t+our• ~f- F j t~~ d~+tA V ?ERFpRvEGI ~ cr Salor• ~ YESLy NO~~~: a a Y f ns an~ t- s ~~XR~~f MOIN Wu11Y OCCUIlIlEO (~(e? s~frrt ~/i~jar~ i~ PWl I M Pa?! ~J Ite~ ~ s ACC1DChT SUK16E IqMIC~t+E dl:po~t- L. ? ? u t:c4 ot ~ -i 2Jc T~~c os J?a.• ~ta~r~. ti.r. Yt.? OJ1~J. s ~N~0.Y w. 0 D''~- _?.id. ~w7~RY OCCL'~AEJ 20r. rut[ o? uuu~r c~. ie v~nsrt b.~r. IO/ CITY. TOYrM. O~ IOCATq11 OOiiATr S~ATE . 1MM~:[ AT Q nQT WM~iE ~ ~N/. Mru(. o0ict Dfl~ . Hc ) 1fORX AT MjRK 21 !~rt~nd~d fh~ d~u~~~d /~om to ~~ndl~~t s~~ ~~i/i?~ on ~ v~+.~~ i i ~ D~~eh oceurr~d ar ~n on fA~ t~ at~t~d~Lw~: ~nd o tM awt of mr l~~o~l~d/~?hom th~ e~us~~ ~t~ ~d. cll ic•¦• 22~ stn?u?TURc .r. ee a. (~era.. w ?1n eoouss ' 72~. wre swKCo c e~ p 1 t t• t ~ ~ ~ t~". ~ T~ ~~~i~.rs~`~a'/~ /~p ~(J •ceu~~t~. ~ S:a~~~.~r~T~ 23b p~TE - 2k M~MEO~UyETf~YOACR[YAT011Y _ 23/.IOC~TqII(CY/.lavf.M:w~afp (SNtt/ . i4rpvAi (1rrt~/~l ~urial ,_~an. 2itus~ille, F2a. S. ~612 j~ tUx[RAl D.- RECf R S S AOW~ESS . d?TE IIEC _~Y a.OC~L REG. 26• RE6i57.UR~5 SiGNAT1tRE .,y,a ' Titusville, F2a .~s"y - ~ • . z.. ' / %~~a r ~ t 'C~ { I 'f~ ; ~ i I H~REBY CERTIF HE ABOVE TO BE A TRUE AND CORRE 0 ~ _ X,T, CT C PY OF THE RECORD ON FILE I\ THE LOCAL R~C~ S 'S OFFICE IN THE BREVARD COUNTY NEALTH DEPARTMENT. - '~~a~••r•'c •^~fi (Not vali~'unle~s L°t~~~'~al of the Brevard County Health Department is affixed) - ' ` l; Q~gIgIED : , . _ ggCORD i ~ s°~'' fILED ~NG C ~ APR~..2~°~.19~~ - ~y: • - - . . s',~ _ Deputy registrar - , R Gwf~ =~6 27 Pi~l : OS 144823 . FiOGE;t F- ,aS. ~,~~RK ~ i . ST. LU C+E` ~ Y. ~ R 144 19l FLORIDA BOOK - .~~~Y» t~ _ .'e _ y~.,_;: