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HomeMy WebLinkAbout0775 i ~ ' .J . ; ~ . . ~ ~ awr^ . . - . . . . . ~ , ` , . ~lYi. ~~Itl~ ~~~J~~'~~'t# ` : - , _ . . : ~ x n ~ , e» .iwT; sowwa c~ ~~su.~+ . C~R"~IFIC:A'T~ OF :L~~ATH.. • ; _ ~o••+ • ~ :•ur~t~?u QI V1tA4 ffA'17/TtC~.. R,~Tt: ~IL[ r~o. _ ' _ - _ - - - . ~ - b.a~.n~„ . , • . . 11 AR'1.:NQ . , . .~YO~+r 7 ' t .R411C't~~r/ MI1T1N , . ~ ~ ; ~ COQi~~_tj0: . WyAL ~i AR ~ . . °11wvM~w~ . ~iw..~.~__-"--_ - . ~ ~c~utr0 - . ~ . ~ ' . ~g74T4 ~ R: CS1UwT~ . ~.e e> > t•_ a cv~M~r t,~~ :.,~ach :'lo.rida . FRLt: 1~!l~Gh ' bv pT~oed. ~ _ - - . . ,~iS IIES~D[NCE . . ]11 . ..v f?_. . . 4 ,.C+FY 107fMr 7R,.COG~T~W1 - , . r ~.cS ~l~Q-UF QERTN.~ . f`G471'. TORM, bR IOC~~pN - . ' ~.YMSIOE TV~ 1,iMIT51• - . "IMSI tiT1t. 4iir1Tlt ; - • ' ¦~nRnL' - L$~iC i~C.2'~'.~1. . j.i3}iQ Y~Q'('t~'3.. '.rss... ris~. ~+oD' ~ "p.~.....:,'' ~ ~ ~ t: MlME QF U~~e/ n ~itpMaf, lwr Hrtff Llhtp~. . • . . ~ ~~~.~'STREt~T 4DpRF5S ~ ~ : . . - - ' . . ~ -•'~s•~T,~ o" , euer.' °~c~:~ itAi ~OQ. 1'ortti C• ~tx•ee~ ' ~ ,«s.~t~~~o~,I.a,c~t ~;var ~r : ~ ~ ~ _ ' . ' . l - M~Y!' ii ~ - ~ ~fJrM ~ .~,~fIN?r . ~ ~Lvt . . ~ { .DAYE ' ' ~~,~Io~f4 M~ Yttl , . , Ib ~ . n~ o `m~ai • ~ . ~4~:~RD ~ wT;.,L~AI'f :~Iv'^v . ~o°FU~~N ~~~.n~ary l~i,: l~b . ` . . ~ . t% ~ ~ 6 ~COIP~ b~~, nACE , ~ ~7 ~u,~~~EO ~'NEYER M~IIR~Etl~D !~.•RA~TE Of l~nTti ~9-. ~6E.~~J~'~tV1 ~M1MOt1l~ 7tlit .YleL1111 ~ . - . . . frat Dnt~lql: y,,,~,- pM'. Pwr. Mi.. ` + - . - ~ . - . ~ . . . . - . . . ~ ~ ' . t c. 1+r.Sle i;.h~~C.. r•:W~oowco~ w:voecco u~u.+yY 11+ 1~14~ r~l ~ ~.-~pl~ln.ly tOf uSU~40CCeN~T~ONrGi~ai~qlo(4ort ~i ~OA ~.~MDOF-~WSiNE~iSCR:lildc7 T119 ~ . ~ tf ~i. ~a~. n . - - . ~ - - witA'p~? lrli+el+DONOf~prfiaRkJrersR~)~et~~N~ p t ~~1i0 ~ ~.~''I A ~~n~nf • . , acka~e :.tore~ ~.ret~zor, ~ . . • ' a.9~3', CI' - , , ~ Y*.,MOT/IER 5 1~pEN IIAYE ~ ~ " , . ~Dl~qt _lOk . 13 ~iAT.MEA S M1~ME . : . ' . - ' . . . r ~ ' . . . . _ . o~ ~ ,.3oseph. Lang ; 1-`arie ?abiona ~ t'7D.}~rit~r~ ' . . . _ . . - : 1S~ WA8 0E6fA5ED.F'lE'R .N,1;• :5-.~R'~wEG s011Ci5~ ~ , .-}6 SOCt~tL.SFCGRtTY f{p Ij IMhRMAMT 1 iIOMATUw[ ~ . . . . YA. G.~ ~ rwf+++R' .It1++; h~c wv~ w 4Y: r~ «w~a+'~' . . ~ ~ _ . ~ ~ . ~ . ~ Yea~ k.w. t~2 ~w..:.., 509 ;~o. C 5t.' I.:a e- ' r ~ . ~e. c,tu~ or.w?rw t~~r•• a.tr. wce esr,r prr h I~ ,n~. oR~.~~ . . ~~rAt ~E*MtEi+' ' I~YA~ ~ ~ ~ . ~~RT ~ ~ OEA7M WAS UUSEiS AY : ' ~ r ~ ~ - . ___~_.l+~ ~I~ OEA., . ,dlflCtOr w~ ~ I. ,Y~G ) . ~C . j , ~ ~ ~¢~i~ll~le: ` ~ ' ~irwEdUTE 6~USE t41.~_~~3~~.'~..,,._.~-~--~d~k~.._.~ . . - ~ Rh• te~ ~ : , ' - ~ . t. ~lCl1 Co~/itioxt rJ twy~ DtiE TQ tb) C~ F ~`~'Ir~ ~';t a t~ sltde~N' - ' ~eL . y • ~ w 1 t A. t R~ . ~eAid paa •ue ~o . 1 o c " w l ' . ~Dete 'rs~car'1~).- ' ~ . ~ ' ~,r~ ~'a~ t (f 'r^~ M!fiiN l1f Y+tAti- ' 'y~.~`` y , fiLs.~".L-~~~ ~t~6f r• l~Lr~t~. . , ~ DI;E Td E~r !:*~~Lr i~..~ 'tc L,L.~,;(~ ~ - . s , llt~" lap+t . fut rl S A .-'-.-ilE-7l~.~-=i~::. . DISFASEfOMD~i10MLMrYl~~f21f~1 - . 1104t~~a~- F ~ . . ~ . . :.tn . ; .,,~„y~~t ~ l h,' • . c~ . y ~ ~ ~ , t" ~cty C ~ j G!.-s f ~ yF.S ~ NO~a -~s-..n~: ~ ~ i_. ~ .Y - . T - 20A ~DESGRHE ~+t>w^uNvrFr_ix~+~+tkii= : a ~sturs.a t~ut l_o~ f'u[ 1Fo~ 'ver._Jd . _ _ . .¦akfa~,~art7-". ALC~DEMT ~~.SUtC~OE :~?qMiCtDE~,,.. ~ . ~ ~ - - ~ -~a,~.._._~~. d1~P»sY= . . v ~ ~ ~ ~ t3en ' o f ' - _ ' . 2pc TIME'OF if4~!r 1y/eaM._:O!~1 Y~~r ~ ~ ?ed7.~ . ~ . , etaJ~`ItY. - • : . . . . - ~ . . . . . ~ , - . Q ~ . . ~ . . ° . ~ , . , . . ~ .~OA. 'MJUIIY~OCCffR11E.D , ~ZAt xLA~E Oi IKJUIIY tt );1~~W ~NifJOi~f ~lJ CITC. TWMN.011lOCAT10M ~ COUpfY ~ ' SSAT[ - ` Wi~'tF.~T.n. Nqt`MM4E ~ Ia~fr.Ntiarf::~traf s~itt~/M..Itt_) . - ~ . ~WONR --".~--/LT11~11ic . _ . . . ~ . - . : ~ . , . ' ~ . ~ . . > ~ / ~ . ~ - 2f' 6!' ~ ~ , to. - ~ J ~ "~.~'.4? •ndlut a~s ~"~Iir~on ' . . _ I ~~Nnd~d tM d~e~aNd.Yro+re DNth oceuried ~t . ..bi.,oA tM d~t~ ~t~tM ~hw~. ~nd ro th~ b~a/ ol m) )~o~Nd/~. /rom tA~ qui» ~t~f~•;' - ~ ~Tt DATE- O ' ' - . ~ 112 : .lt~~s . - - 22D:.AODRE55 - ~ ~ N~11R . ( pt/?es ~ tYItY ~o s. . H.D.. ~Lake ~~+orth, Florida ~Lt~ _ eo.pl•e..: 1~ . c.{` / ! t ~ _ _ ~ . . ~eeu~at~. ~ . 23r MJM4L..C~iripMr 23D - W7E° . . . ~ . '27[ ~.NAME'Oi[[ME~R.7~OII~C~EY~TORY- ~ - 231 LOCATION lCV/. t0~if1. Ot[O`1f1) , ~ . . - ~~w ~-~wnh, 1/17I196~b 4~fmic> ~ G~rdens L korth, Flori _ r'Y - . .Y. S~.t612. 2~ ~ U.E S SIGNAT ' TE RECQ. ~Y IOCAL 11EG ~ EG~STRAll~S SFGMATUIIE f - r.i.7~~~h $U11 . : ~ 4.;.,9as Lake Trtort;h F~orida~. - f I~REBY CEHTIFY THE Il~t~VE 'I~0 A TRUS A~CT COPY OF T'HE REGISTRA~!S R~G08D , ~ F1IE IN .THIS UF'FI~E : - ~ . . _ 4 ` (:No~ ~ valid unleea:~ tihe asat of the Paln Beae ~ th ~ ` + ~ 't . : Dep~rta~ent in atfi~ued) ~ CFRTIFIBD CAP'~ ; - . . . . I.... _ - ~ I~ooa~t . . _ ~ ~ ~ . t Jawuary 27, 1966 . ~ - _ . . . ' , ~ ~ ~ - ~ . ` _ - . ~ r . . , , ' . ; - ~ • . ~ . . . . 1. . . ' ' ' .6.~ F r ~ ~ . . . . . . . . . . ' . . . ' - ' . - ' . fs ~ ~ „ ` a - ~ ~ •,a: = - ' . ~ ~ ~ ' ~ ~ ~ ~ ~ , f . . . • a ~ ~ / ~ ~ - - _ . . . ~ . - : s - _ _ _ _ - - -