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HomeMy WebLinkAbout0277 v v / - ~661s ~ " G~:~:1r:L..^-.'t~.Or D~ATH Qt~rA~tw1 ~ t1r~~1~ ~nd ~t{~a{.~j~~rl~ve 1tr~~ct~ iTAT[ IILC ?~O. k ' 1N~~:ivN t~f' +~t.~i ili I L ~ i7 J~ TV~E. Q~ ?i~ht IN ~r~~1fYR~~Yf~s ~ Ir i ~ REGI6TNAq'S NO. ~2~ ~ a:axww:n~ +Nr pEGEwSEO-h,~rE ~ iif r.viw~ F~1 SFX ~ W?iE OF LIfATn ~•o.~.. ~.i. ~ ~~;R~:7~Gr1 , ~ti'lyLin'•; - ~Iale Septe:nber 19, 1971 i ; C~CE.~.n. ~~ow....~.K.. ~..~w. . wGE-~.u ~ - • ;..'i J~ 1.a7N ~w.~. ~ ~ . ut. ~ ?irc.n ~ i ~.~iy.r a~~.~s., . .....u . • iGO~INTII 01 OfwTn s GJ:i~ ~ ~y::?ta ~~.72 ,~'a~~ I7,1899 St. Lucie ~~Sr, l~MN. Ql \«Aj~~l~ Qf p(AiN ~.'.t~. e< (n~;~~ v~ ...ncw w15i~~ ViK7ti-NAMf wOt ~w M~4~, M ~tYe1 ~ . •r ~~S a:~ wJ 4 ~~O wWH~ ' n F~. P~@Y'Ce ~'c.a' ~~a.S.`.2Y :id:OY t ~ ' STwiE OE ~iTh 1 J AOT w V.~ ~GT~Ifr. Of wra: Gv..>.:+v-' w~.:.:~. ~;~::.r,~;: ~p. .SWV~vM. S~WSi ~w ~rt. ow~ .w.oa...w~ ~ towm~' h.:- ' - :E~,v~crn ~ ~ Illiaois ~SA ~ac .:oily Schwartz - Y` y.ru :H.ni SOCIA~ SICYI~P/ MN~f1 ' YS~.~AI ClClu/Ai.O\ . o. awa o...+:. Nu w [u+0 Of M.S~ESS OI1 wONSli1 V.~...~;:.w; 090-03-2798 ;~:.~mra~=~c~ =r~~,~~ Truckir.g , :~t .s.c... iFS.JinCE-Stwit ;COuw^/ .C~:Y :C.~... . ~ . . ..~:~'.p~ ••~•s~ c~n ~rm 'Si~EET w+~.0 nuwUi~ = ,..Florida S~.Lucie _ ';;;`~~o«~~',,,n33 Beach Ave:~ue ~ - /wTtiE~-n.wi r~uf ~..rx1 .v..::niw-wu.JEN f.~AAE r~~~~ wrw~ u~* ` Jacob J~.coas:,.. Libby hier~^~an „ ~IrFCdMwNi~hAMf .v_~.,n:. w:.:..:c11 uqHt o~ ~..1...0., csn w ~oo, y.q. ~r~ r T _ 7~10~ - Lt.Col. ~:3r~lri P. :,acc:,> San Diego, Calif. ~w~~ DfwTN w~5 UuSED ~r. - . - ...•a.,~.a ~ ~ ~ :,,lE rCi • ~F fJi ~a. .o~, A+vJ ~ur.u~ ors1~ •~0 0~.•. ~ ~r~w! c+ua n ~ :ol /,'1 n~ ~ 1-~ ~ t~ ~ ii +7':25+'s.3.:«c. [""`~7 ~ ! ' =o»a.~~o,~~. ' - ~ ~ .~s~ +o t le~ ~ ; ,.r~ : w+ ~ w~ ro, w~a . cu-u~.a-:~ o• . - ~..c . •i•= ( ~ ~ o c•..w ..s~ _ ~-'9r'.^•~~^ ~ ~ai ' Iw~7 w. OinE1 S~C.i+NiC.v~i CO?q'hi~5~ ca.auo-.s co..•.~~,..,, •o :ur~ •.i ~.o-.~..v: ro:,.u c~.n. ~...ur ~ w~ .wU;Wir u rES .w ...a,..c~ cw+- _ n. jr •o~ : i,a..u a..........o u.u ~ w o.... ~ .a,s~.' ~.'~,Jtnt. Su.Z:JE~~'Sw1E~i~iT1-, - ~b'L~ ~~h . ~ Nr.:~.3i. Ol ~tOlfE4~wt0 i o.•, .a.~. -~J~i nJw ih~~~V OGCuRti~ ~ 1.~~~ ...r,~M M wii~r .w r~~~ ~ W~.u rta~ ~1 ~ - c+a.I~i ~ ' 7:/ . ~Iah~1Y A1 Wui4 r.~CE Os iN~lA1 .t +J..~. r. a.~ ~.t:••~~- ' ~~~~C~rt G+O~ OMK~ w?4 , fK. . Vti.n ~ ' O~ ~ I O. w0.. 4f~ M~O~w. N~N r :C• .'.`Di " ' ~fi::fi~Ai10N~- ~6~iw w~ . 'v~ .n ~ ,.1 Ow . i.D/OV wOi ~.~~r y~JIATM ` OCW~~10 •r rv ~y~f. p. fw! a In~~K~~ti: / Tv . . w~.• l~~ ' ~00~ ~~~1~ N~ti. ~wOV~ D~•1 •~.D ~J Nf+ _ ~~,.aro aw,..~ac.. - F. cr.~.s~o .w~ ~ ^ ~ ~ _ iEn.r.G'hr~.-w~EDMi Eiw~a J: C ~~.~.t; = a ; J `r~ 7 1;4 ~ ' I:• ~ .~~:iw, o .i e..w.~~ ~~.•eo t~.~...'.r.:.~ ~y yyr ~nr~0~ iV +r~1~•4.~Jti, C••: , ^I J~~'.w~tw ~U W+wk'~CfI Ol~O { G~~~w OIC~~~10 O~ ~Y i~~/ O OM W~ 1(~~sa,f. s~ N~ t~~~ ~Ow• _ N -:t N Ci.S~~.ei-~.~n+E ~+h o. . , i.-- i:- eeen~ w~ny D~Tt 5.::~.FD ~~o+'.. w., i, /~I1~,`~i' ^ J ~/i~ ~~~1^ ~~:Gj / _ r~.,.r.G wJJ~iil-Ciairs:fi . . . - _ ---C.- :o~.. f 1" ~ r _ ~T /J /j/~C') :I_ - ~ ~~-r • ~1 t~ IrC1 ° IlY n ICY,r~j i..i.y. GiMAiiON, itMGV~~ CEw~:;c<~ G..~.+.'..•r-~_,:. ~ s..c•n ~ , ..r..S~Jh cm a a... s..r~ ~ ~-•ri~~. ___c_~s- :c-~.. -:s ^t. Pierce Flori::a - ~ J.tf- ~ ~b...., w., F..n~.•...- :d- - - - - .•a o. a•. n. ~o.. .r~. ~ Sea- 21 i 97' 3ai~:;~_ ::c_~, j;;~ 7ta St. ,Ft.Pierce,F1a.3345G Y. 5. ~;,:i iW.E~. J.iiR /~~y~ ~iE~ ~ _ r„ f ' O~I[ 4' to ~I •1:..•' _ ..r. ~9'3 ,y- ji !~/--yr (i~ , '7~'=-'?"=' ~ ' , ~ i ~r?~r~a~"._'h?^ i.j.. ~c7 ~ - 1Y ' ? _ ~ haroby oertify this to bs e true and corrE,ct oogy r;s L~~ I = Re~:shafs record o~ file in th~ St. Lucie C~v; ry~iV3;;h G;~,;,K- f1~EG atit c.E.~RDfO n~crnt at fioA Pi~ca, Florfda. ST lU~•t C~UN11' fLA. RQ;Fr~. POtTii,~S ~ - (Wsrning: Not var;d untess ralse~o sea! of r!:e St. tucia CLERK C~RCUIt COURt~c` - County Fiea{th Oepartmcnt is affixod.) REC4Rn vE:.~F1E0.,~,.,.. , - N. D. MILLER, M. D. ~~T 5 3 24 PM ~1f ' ~ ` Count~ health Off+cer t: l.xsl ~:.~ist~a; i ~ ' zlssis ' : ~ s#'L~ t~ ~ ~ ^ : : ~7 .s ~•e , ~ , . ' 0~ Dsputy Local Rooist?er 800K~~7U PACF z~ : - ~ _