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~ , STATE DEPARTYENT OF MEALTM OF NE11 JERSEY )(t/
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~RECORp VERIFtED
Ra~-4I +t a,~ . NEW JERSEY STATE DEPARTMENT OF HEALTH
~ ,~j'~,?t~ ~~r - ~
~ Ju~Y ~ ~ z " ~ TRENTON, N. J. ~~;6 , F~ ~ .
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3 : ~
. ~ • ~ ; 66 ~ 14`71s2 ~
JOLY ~6!_~2 : O~T~<<g d~.cly
~ ` - ~LERK CIRCUIT COURT f~
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~ THI'S IS TO CERTIFY THAT THE FOREGOING IS A TRUE COPY OF A RECORD IN MY OFFICE.
~ g.v .~C~ "
~ I Sta~e Regis~rm o( Vi~al S~a~is~ica BOOK ~5~ S~a~e Cominissioner of Health
3
, WARNING: ~0 NOT ACCEPT THIS COPY UNLESS THE RAISED SEAL OF THE
STATE DEPARTMENT OF NEALTN IS AFFIXE~ HEREON.
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