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. acwnoa 2~ D~TE Z3t. NAME OF UYETEIIr OR CREYA70AY 23I. wuT~ow (~V?. u.~. r cwary) (bt.r•i
j `..Eemo~'' 3-18-68 Boneventure Savannah,Chatham, Georgia s
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J~ ~`j FfLEO AND R . i
i hpt •sectify this to s. trus ~nci correct oopy of fhe lrocai ECORDEO!
~ fy pepaR ST. LUCIE COUNTY, F~A:~ ~
Reg~tiMr's.iecq~dsqn fils Jn "tFis St. luti~ Coun Health 4
rrient'at fort Pierce,; Flqrlda: : ~ ~ n~ n~= ~ r E D
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~ ~ f7 \ .Nc'C. MILLER, M D.
. . . ~-Cow?ty Heelth Officar 3 Lflcal Rspktru ':U _ •
. ~ , / , CLERK
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