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HomeMy WebLinkAbout2689 ~ ~ CERTtFiCATE O~ [~CATH ~~e~~tmeol o~ ~~~~~t{i ant) K.~.~~.I~iLdlre Srnlces F L O R I D A 6TATE FILE KO. IN\1:'.~~ /k Ilt ~I111 ~~~N7 u~ •-u•• e+.n.,.,.nm.s rr~~STRAR S?30 ~ , < ~:tNT ~HK - , ~ Qc:tiSE~ -r:4M[ ~,u+ r.ro.~ SEI ~LAIf Of DL~ir• n•• i:~ r~a_i:`2[!Jf i~;~~:.~rors OTTO R. ?~4ISC}i Pr:~lc~ Jarit:;.rv ?.0~ 1~%7] - -i---- RACf n~G~J. ~rl~~(~w ~w~.~w. AGE--a•fr ~f~ ~~1~~ 1 C~___ ' I:AI! llF 6 i'.~ ..Jnrw C~•. ~CJiINTV ~ nFA1H ~ec ~ s.~~n. : 7~.~..ti .a? + o.~a ; .o.,.s ~ , . 1 ~ , , ~ir.f ~ ~ 1'.n T~y'IZ_•"]i'~t i ti~3~ll.e ~5e 7'( ~ _ t -•-~---L: ~~4- - - - (~l11, S~.v:r~, GR t~7~~`. Cd Lii'i~~ ci c.n c u.~~J ~~~..gF:!~: Gc C'':t: r.Sr~'~~' _~j_..~ . t•~..u, ~.e n'.re~ .._..~e.. ~ / , - - -~s•ec~•, .~f O~ r+' , E...~, Fo:r,nano Feach ~ I~, No t1orth Nro::~ard_ Ho~r.ital ' " . _ . - "'.~t_ _ _ _ 't'JEYiYI~:I'• hJ' ~ ' S~~TE O' E~in ..oi , s. ..~IC~'i1tt~ Ui wr~~t CG::~:SVr . aF;~iC Mvtr ?~.cs i:. S ~S. ~.n. e~e r.~p~ti ~ r•~.i~ VI ~ ~wtL. L~+(;i~Cl'. »r_ , Illinoic U.S.A. ~~~__t.'arried Sue Stroble_^._ A _ . . ;~~r.~„ SOC:tt St:Uj'~ ltVw.ltR ~LSU~I (KCV~~•~:JN .c awr w ~i•+i1 Oi FJC•hFiS C•i :h:vU51A~ .c..-.o;~i :.~~.,.r.:~~ . 31?--30-9364 C~~~ne_r. - 0-:~r~;±,,~' ~ t; ~;~ch '~:~~?1u~. ~t,?i-~ n~------~ ,~,~.~.t ~ - - . - - tFSAt~CF-SiAIE CQUNi~ C~IY, iOwN. O[ IGC~IiCJt~ i ~~e•ce c~*+ :S•~EfT AND N;;ee6!i , ~ i . . ~!]~lCl~~ \ll O~ Np1' - ~r "~.C~T'1Cic ~2~O1':c3~:; t::; I:lF~}':'ih: ?~.^e Pn :nt Vf~c'; li~. 1951 . ~ . ~Q~'11 Ci.. !cT•., •.c•.:f r~~~: ..:.w1 i.- )i ilu.(~S•~4fi-M.:•_.:h NJME r.~s~ r~.o.e ua~ - - ' ,5 }:er~~~~n ~.ri ~-~h l~n~t~taina:~~ ~ . INFOiMANi-NAMf MAlilh'G ADA3ES5 ~S:tll7 O~ ~.r.D u0 . C~t~ q tOr^~, f~~it. 7r~ 33oG4 t.:rs. Sue ~.:isc}~ 19~1 ?9tn S~. Li ht},~t~se Foi,-:; . ~'1 fwRi 1 OE~1H wwS Cw~SED ~Er+lES Ut~t? OhY CwuS[ ?[R ~,hf ?Oi (aj, fbj. A~:D j~)~ ns.u.. o~ser .•:o oi•rM 1t w..io:.-n v~ e , ~ ,l / t (°i ~C~/'C!j~~j~/11J ~L~~S , ~O<l~/1j/.~1a.~~ 'JiU . v . .s . z~•.,..,~~:, 1 r : .f ~ ~o~~,,,~.s. , / {I ~ ~ ~ ~ l~~- ~~rr ~ S ~ rIIGs ~ ~o ~o~ L ~ ~ E a Irr~L.:~tl C~ull 10~. L _~'_'f~-~__ k !\~t~~.G lwf Y~+41~- ~ ~O. G~ ~S 4 CO'+SIG.:••,t O~ i.~~o e.use ~,st F -c- i ~ ?wtl b OTHER S~Gr+i'Kwr~i `OND:T~ONS~ ~~~:+~a. cu.no~u ~.+e *o a.*~ ~,r wo~ ~e. ro uost e.•~ti w~•~i ~~o~ wUiO?S~ If 7fS ~u~ •~..o~~ef eo.~~ ~tN M~+0~ f~Dt~l~ GOllYir.:YS C~YSt ~ ~j ~ / f / y~j ~ s ~~``1_1,C~'T~/?=~1Z~~ ~/(~7~S ~~l~!'...~~~rSPa~f' ' 1 ~CJi'J/E~S //(.r'~/~/~! ~a J~'~ „oe.,~ °5 ~?rpp~a.t~}j/(`' f'JENi, VJ:C~: E Ot DA~[ Vr ~1~Y (r~Hfe~, Wr, r1.~ 1 N~U~ HOW IN?l'[Y OCCU[RED ~ lw,t~ M~Nf! O~ ~Ntu~T 1M ~~~i 1 q Iwt1 ~1, p~r 1~ / ; fpMIC~D~', t•A U~:OE/E[Mt1ED (SKCd~~ T ~ ' ~ . _ . ['y . - ~?0[ M 2fi~ Ir~JJRi w? wC:.K ^i3CE C1 ;'.~„z~.• .._..e S'~•1~, r~[~:a.. i IU.Ai~?N ~s•n~r o~ o. «o , e~T. u~ io.~, s~.~e ~ ~ ~sno.• .es o~ ~o~ ~.~ce eu .s•ec.~.; ~ ~ p~ p! CFR1tFtUT'ON- .~.r~ o.. n.~ ~ ~.Ow-w o.. .e.a us~ s..• ~.•/~u .t~.e ew o•c•_.o.«:r .~ew ~~e~Dta~H OCCU~RiO ar r:.cr. c~-. c~: z ~N~S~U~p: w r r0.•tw D.r ~t~t ~00• ~np Dfj n~. ~ Ou~~ O•tt. ~••D. r:~ ~.E tfi• . ~ ~~nl..et0 lw! J~ / / 10 n ~7 Q j/ w... a.r,,w.er-.•, a~n' ~ '74 o~te.s~o .•o.. o'~ .~~7 ~E y I~t! _ 1 ~ ZV~ / ~ - / ~ ~ / - / / tlt _ U~I~ : 1 ~a ~ to ~.e uus~,s~ si.ito CE[ttr~'~t: ~•~~:;~w. U~,• *•~c Oi CC~7tiE4 c•..~ ~.s.s o~ -.i a w•~~ Ir.t CI(I:t•.f r.~S NOvw~..f: L1~0 ~ ta~r•«~i'vw J~ Tw! L~[ r: r.f •..lS'? Cr. Gs~w.C•. r~~M C~I \I~~ ~O~l~ ~ _ ~'1 1 ; Dl~tw 4CC~~~l~ OM M! D~~! •rD G~.. I'v T..t C~..S! S~ )1 ~l~ ' _ - ' - . _ _ t!s ' . - _ _ : M 17! _ ~ . _ M _ ~ CE:1iNEG~--r.~„E >,•i c. n~~r. ~ g;Gti TU~E : -i. ~ n~~rer o~ • u ! GA.E S~i,'.EO.- c.¦r i a~1 ~ ~ c> //7•~~~ ~~k Jan. 21 , 197 1''f10^1DS01'1 `T'. R3~ti'lSa jYi. D~ Irx _ ~~7tc~.,~~~v ~ ~ MAIIWG ADLMfSS-CLilllc[R • sn~n or i i o -T' u*r s~•n ~~r l` :l: ~j 1! O n r 2 C• = C r~ r... . . r, l r. y~ ~ ~3 ^ ~ ~ Jy/~ ~ ~Ukl/ll. C4i~µT1~N. ifwtOYAI CEMEI(R~~O~ Ck:MA~ORY-IJAMf ~~~ATI~IN C:n W Ipww ll~it ~ ~f~tun~ _ _ . _ _ ;y r`r + 1~. ~n..;~ ln~ ~'i~n ~~-tr~r r ~J~~ F~W:ei ~ ~ e.:a ~ier t_. Pa L•. ~._,~._1__._ ~Q__ acr}_"r'1~3a ~~~1 ~ DAtE ~.•c•+*+, o.., .eu i fUN:CAI Itv.NF-tiAME ar.J n~ V.~SS . Si~fl1 a~ r~.v ~o , c.t. oe ro.•.+, i~•:t. t~r ~ f . ?ie ~T_` ; •1 t f -1 9 ~ :S• ? n P 1 '1 C C ^ ~ ~ t • -i r = n n Li :?l ~ n ~ L ~ ~ r w7p'uCl~rE~ N IOC~i tfG~S:~~! ~ . s Y. 5. f61? fUhtE~~l O~RECTOR-S~GNAfURi i fiEG:STRAi- ~r+A1;{ff ~ a~~.ivTO ,s, j,- ' i-•r~~ !i"-~/~~`/ l' - ~-c~~% `~:'t ~ . . . . ~ v ~ . ~r; - CF.RTIFIED COPY ~ I hereby certify the Above to be a true and correct copy of the Local Registrar'g record on file in tlie Brorrard Coeinty ~iealth Depart.~ent at Fort I,auderdale, Florida. - ~ ~ (W~crrtittg~YlN/~t'~v,~lid unless r~iced seal of the Broward County 1lealth . , ' J .~n~tir~ent is affixed. ) 3 O ; ' - L ~ ~ 'T ? 's ° s ' ~ L'.'•i ~ f. i~ • r- ~.2%~1%~~? r• If t/' ,w~i f'~'~~ i - ~ o ~ ~ .~~f~ 1 ~ ~ . . ~ , F11E0 t.a: -~fCORQEO ~ 3.~;.~". County Iiealth Office~ and Local r~egistrar ST.IUC?~F~F,~~RAS`~ t~ : j~ 3 T ~ Pd6~ F::~ . - Q c~E~K ~,,:~cu~s ~oupt , ~~~r st',~, ~ ` ~i lifC4Ri,1 V:".' ~ EO ' ~'ra 1~,~ ~ ~-~4-~2' s~. ~ ~1 l e 3 59 PM Deputy Local ke~ictrar ~ n