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TT~ Plantation Gen~ Hoepital 4680 S.N. 25th Avenue
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socu?i sccuR~Tr Mo v. awo s s~~uTUw~ 4680 S.W. 25 th Ave . ~
318-22-210o Clara Adona Ft. I.auderdale Fla.
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~ V• 9. tA12 j~. Ml D~RECTpt ~UNE ' pRES j5 pAT. RECO. ~T LOCAL IIEG 26. GKTR R'S S ~A TLR~
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RECOROEP IN OFFI~IAL Rf ~CRDS BOOK
CERTIFIID COPY Of BitOWARU COU1ii'f FtOR10~
' JACK WHJs'ELEB
CtERK OF ClROUf1 CAIJRf • S
I hereby certify the above to be a true and correct copy of the Local
. Registrar•s record on file in the Broward County Health Department at ~
Fort Iauderdale Florida. '
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~ (Varaing: Not ~qalid unless raised seal of the BroWard County Health ~
~ Dep~M~ment is affixed.) - D ~
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~ !LlOSI~ TO GRl~ll'f E. Wt?fRS7EHN '
~ ATfOAN:.'Y AT L.~ W
~ SIIiTE 425 HFP'-~R 1-r SZIL ~ )Q
~ P. O. DOZ 6537. STrTi:.N 9 . V R 1~3 PAGENv~~ ~
_ FORi L A
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