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.~a .~~i Saint Lucie ~_~y~ STATE FloriBa 001NT1' Saint Lucie
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~~~a Ft. Pierce i~~e:~orial ~?osp~ta 115 Poplar Ave.,
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Selma Ler.o~a La:~Iont ~,T„ 1%/ 19~0 '
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y=~~G~ Floyd A. ~:::ont S15 Poplar Ave., ^t. Pierce, ;•1?.
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Fort Pierce, Fla 1/20 68
~ ~o.p~•~• a Mel ` kowsk M. D
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C':"e~+`~~C n ' Z~ZI~Su Pierce Cre::a:ory Ft. Pierce ~lor~da
V.3. ~A1~ ~ * 2S. DATE RECD. tY WG1l IIEf.. REf.KTM~'S TYRE ~
te~'°°_"S3~era~ jJOy • r.
F~r.3p66 r~~ p~ erce, ZOil~ 2.,~. -(p ~ ~ c
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~ . FILEO AND RECORDEO~
~ C;,,~' ST. LUCIE COUNTY. FLA.-
~ i j~«by ~fy~ th~s:
te be s ttue snc~ correct copy of the Loca l R E C 0 R~ V E R! F! E D
: itegistiatrs~n~car oo file in the St. Lucie County Health Oepart- L c~ Q~(,
:-rrienf at fort a' r~se. ~florida. V 0'~+
~ ,_(Warning: Not vard unless raised seal of the St. Lucie '68 JAN 2 P 3. Z 4
~ ; - ~ ~County.. :He~h- pepa~tment is affixed.) f~~~c-`~
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~ " . ~ ~ . . .
~ , ~ + N. D. MIILER, M. D. k0i.r ?~`0lT~iAS
County Health Officer ~ local Registrar C L E R K C I R C U I T C O U R T
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~ ~i1~ ~O~Y~I ~OC'~~ RO~IS1faf ~ .
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~ B~K~~O PACE 659
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