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HomeMy WebLinkAbout0807 ~ CUNNFCTiCUT STA1'E DEPARTMENT OF HEl1LTH P~?Ik H~sitl~ Stati~tie~ stetie*-Ha?lf~~. Gwwtctic~t U.S.A. ~~A~~ ~itl'tlflC~itf Of ~Q~~ ~ ; ~ ~ ` 1. Ta~cs M Ds~?tM: Is1 Stab K GwMetkrt Uswu. Rs~asM~s M D~w?as~i Is1 statt CiOM@CL~Clltr l~) OM~tf ~el 7N~ I?! pa~b lel '11r.~ tal Ra.Wewee iw.:~e Fairfield 3txatford Fair,field I Stratford ' u""'~ 1~ N) N~~t HN~ittl e? ~atitrtlM l~1 Suaat N~wDer Ya ~ N~ ~ i s 11~ N~ 1~ ~ MN~W K MMtIt~~IM ih~ S~~'~!l NO. 11~ nI~{~ tih IOC~tiM~ il YM. Yiw! Cil~ M ~ N Nt~tfM1 i 25 Sheppard Street 25 She ard Street Q ~ .~Y ' a ~a K.«s.. ~r~nu cM~+u.~ ~lasu s.8~cu~. Sscuw,r Nv..o °u S S i~y,°..a"'K';.~.u Jeft~cey Hart 041•09-2908-A a:~ MED1~/1[. CERT/FICATION fT~ w~q ' rERSONAL AND lTATLST7CAL rA1lYICULAAS ~ ~ Z s~ C~uas ~r Dsnttt fEwUr Mb Me euwe ~ Ns (~1(?1 ~w1(e11 1 a ~ i. 6ct ~es ~wt~t~~~ ~ ~ t. M~wa a Nsrsa lt~wa 0 , t~?ar 1. Da?rr wu Cwvaw r*~ ' q " 1Mxau~s CnYts (~1 •rssr w~~ ~ s s Male i~Thite ~r7e••• p O - : a h ~ a w~ ~ M DfN~f.7~? il~i IIAOiIf HA1q M ~Cv f ~ ~ ~iw~re ~ ~iw ~v,/ < Grace Van Fossen ~f~"~ - ~ d p~ t~ D~ts M fli~o~ti) ID~f) ~Ytv) DVS 7~ I?) ^t, o~ Den~r Au st 2 1 6 ~ u w•~'ikti C'ar~1~o~7~OS G/c~lerCl y N~ s 1~. Dwts M BuTN Acs /1~ >eus If nader 1 7e~r It ~ider I i~f ~ LO alo~ eao~e I V~ 4~t Mrtl~q) 1[~wtM I Dy~ ltw~s ~ NW. b- Dus tr ~t) / ~ I~s ea~ ~.~Iba~r~p , 3~~ , : ~ ; ~ Oct. 1892 ~ ?l~ ~ ~ wc ~ M cre. i.~ (~irt nss.ak dln*~zJ • ~ ll. atsrniu?cs ICiV ot to~n) (St~te'x feeei~w ce~wtrsl n ~ ~ ~ v i Pw~ Il OTNq SICNVICANT COMMTIoM{ CAl~TR1~V?1NC ri. W~s o~ te Du?rn ~uT wK Rs~.+?tse t~ Tas Tstr~K~u. Aitsrts7t , V~ , Wigan, Bngland oo~M*w+~ c~ a. r..s i a?. rw..xat x l!. UWAI. OOCO~~TN7~ (Gl~e kiai ~t ~rerk Ae~~ ~~riK wost e[ ' Y~!l~ z,~ ~xtia~ Ufe e~es 1! reUna) ? ~ ° S~ Retired Tool I+Iaker ~~Y R~~A~T ~~~»K~ x~~' inx t~~.. y~ (?1 lwwsnnr ~a Buax~fieneral Clectric Ci0• t~l tt~w ol eo~•~ D~te ~eeiKw~ • a ~ g~ dalo~.,:?.~/ f~o.~~~,.~of.:r ~ P-G 61 ~ a` 1~. t~) Mns D~ansn w Vsssiu?Mt 7a er No Q l?I T~MS M iM~~ar . v e; !i. (al ACtasNt Sv~ws HowKas ~ qr1 It 7~u. tirr +ru Nw~ XrwtA. OrI. 7'~t? p S V~k er SLiV ' ? ? 0 ~w. 3 L~. JOlua H~ti ~tl IMJYtY OKYIU[~ Idl P4?Ct 0? IMJUaT If.~~ iu ~r aMsf A~N. ~ x A~ = 1~. Nw~r ~ /s..4 /~eurn. ~en~G H[N i11/~ ~te:) (CIV or tor.a) lSUte on c~eit~ cwwerfl WhUe at I~Iet While 3;~ w~ 8,~.~~.~..R - Englarid v?.~ ~.e wo.k p ~ ~ . x"""• Unobtainable c~*•, z~•K. a• c~,.or ca,~ sT.,: LR. I~AM~ -E ~ a lcia er a.¦1 cS1.te er t«+~ir. ~o..trs~ z'° a ~ (f? Discwc Mer ~niuatr patvup. ~'3 ~ it. e~~~ru?cs Unobtainable ra.~.. ..e..~..~ r*i••v r. r..e t ~ g l~. 1N?aawwws'i w~s ~r Part J! H~ st.) o s Hrs. Grace C. HdY't ~ Z HEREBY CSA?IPY. w~ t.u..~.a u. ri..~ ~ a - : ~ ~ ~ . Hnnw D.eeAueust 31. t~~ ~ - G ~sG ~ . eo _ ~ .x ~ ~s G y . 3 c.~nr ~ I.akeviet~ ~a.e i U.e etk ~«~..~a .w. e. - 2 u C~ ~ 0 9 ri.« Brid e r Co e er.~ a..w a ti..r .K.~a -~f' - l7 ; ' 6 ~ M H~ws oiEuu?~.xat v Bo~* ~c~s BMUUiw Lleeiw ~u~ ~t ~'r2O A• a. John W. Dvors I 1 O ~KA7V~i « r~:~ ~ ;i - ^ 4 : ~ !1. sICNAiYRt M LNi~MiA UCiJt Yltf~Y. ~ ~ ~ nnis dc D~ Arc In , ~ ~ ' • aaa.... • Stratfo Co ecticut ~a~.... • 7s ~rTc ?r ~-~~C ; j:~ 1~. nna csnr~rt~?zs a s_ o : . 3 Au ~t~0 ~ . ( ~*osx vs-~ \ • - . 1 - - - - - ~ I , ~ . CERTIFY THAT THIS IS A;~'R[J~ COPY OF THE C T ICATE RECEIVED FOR RECORD. LEGAL FEE $1.00. ~ - ' : , ~ . - ~ - . p~~. , ; ; _ . ' - S F ITAL S ISTICS ` r DATE • i - ~ - . . N F STRATFO " ! ~ - + ~ { (Not"good~ without raised Seal of Certifying Official) ; ~ . V . ; - , FILEO AND RECORDED ; ST. LUCIE COUNTY, FLA. . ~ H= CpRn V~RIFI~D .162034 '6T NOV 27 AMi 9: 48 _~a ; ~r~ ; C~ERK CIftCUIT COURT BCOK 16~ PAGC ~O~ ~ - , _ -