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lea~l ~~C- FLOAZ~A
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S. SEIf i- OO1011 OI~ OAtE II1~R11E0 O NfYE11 MAI111~ED~ OATE OF MI1TN 1. ~Gf (/µ~,l MwrM O~w Nse Yf~ ~
t• Ha18 ~~ro ~Op1I1ED? dV011CE0 Feb• J"jV~7 ~
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1S- MAS DECE~SED EYEII ~N Y. S. A~MEO i011C[Si 16. sotuw uCU~~Tr No. 17. w s uo,wn~s Fannie Jones
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• t• ~r ~pynt M Hfk) ??i. A0011ESS tlt. WTE SICMEO
~...~.a.. C.C.Benton, M.D. Ft. Pierce, Fla. 7-25-57
• e e ~t~. 27r. M+~:Y. CaEiundL 2]?. WT[ 2k. IU1YE Of CFMETERf OR CIIEM~TO1lY 23/. IOCATION lGY/. M~w. M eM~fp (8W) .
Bur~"~`a.~ ~BOr`~'' 30-57 Pine Grove Ft. Pierce, F],a. ~
v. a.+s~a 2~. suNC~ o~ s srw?twic ~oo~ss ts. o~rc uta ~r we~ ~ca. ae. ace~sr~ue~s srcNnrweE
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~••.•.s• A.T.Stone, Ft. Pierce, F1a. ?-29-57 Anna Lee Denison, d.r. "
~
I F?~r~by terfify this to be s true a~d cortect copy of the locei
Rep;stSa~s're~cf~op~f~~e in 'the St. luci~ County Health Oepart
rr~K at ~~d}t~~sr~e. Fbrida. .
~~~Vlfirning: ~NW valid v~less raised :ea! of the St. Lucie
CouRy H~a1tK Department is affixed.)
~ ~ - • FtlEO AND RECOROED~
~ MIIIER, n~. ST. LUCIE COUNTY. FLA.
~z:~r;;~ t?:t~~~l~p
~ :;,C,ounty Health Officer b local Reflist~ar -
. . =1 1~8`7
. . , 15 ~ ~Z:Za
a,.~ . o.~,t„ a~~ 68 Jul
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::e:;:.~. : 0~1~:.s
SaOK~~~ PACE ~~-ERK C1RCU1? COURT
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