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Home My WebLink About1820 ILLEGIBLE wnen p~esented for reoord ~ 234100 ~ - _ ,..rlwr ~I,u~ llta~l~ aqd ~~~u~~i~iltlire ~r~~icca STATE FiLG I~O.__, . .NYI~iUV tM Ik_\i.lll ~ ~ _ ~ ~ ~ tVVC. Ol ?i~NT .n w.rrwwru~s..s~o ~ ' ,5.~ REGISTRAR'S NO. ?CRMAhiiNi `l~~ pfCfASfO-~/M~F ~~~s~ ~~+.+.t ~,x OwTE OF OiwiM ~ row~.. o.r, rt~u S[[ NiiJWpl 1~1`r ! i?SSIY(1~0115 ~ - - . . j ! _ ~ ~ r ~7 7 ~r C~ RACE ~wiTt. wtr.q. u+a~~cu~ wouw. • wGE-..sr a~~.+ ~ ~.r J~.SF Of LIiTN ~rl~~w. w~. ~COUNTt OF OEATN . feG ~Metwr~ N~tMOa ~~tuY~~•OS. i`o.~i , ~4.~f'-+w~ i ~ ~'.:11 i E: y~ u .,'i'_ .i 1 ~ - 5~ i,i: _ ~ C17Y, iOMM. OR IOCA~fOM Of OEATN ~~~at c~rr ..+.:a ~~FrJSp.7wi OR O?riEi L1SiliUTWN-NAME W~ ~w l~TM~. GM Yt14tT ~rp ..y.yu i, ~~^7 ~ uK.~~ ~ts O~ MO r JVU~ ~ - n -'Oi 4 ~i~'iC~: 7~ ' ~7: " . :~Ci~ `i ~ ~ ~C) ?c: r. S~~tE OF WM ir wo~ w ~.s..., GT12EN Of WNAT COwVTiY r~w;.:.z~. Kfvci MwR2tED. iSUtVIVwG S?OUSE ~r rw. on~ .u~wr ru.~ ~ • cowm~ ~ Ww~:,wEJ. G~v~tCE.~ : snc~n ~ vs~.a~esou+te ~ ~~lir~J~aU~ :i~~ ~ _ i10 . , - . IO. '~r- rN~! WCt•Sto _ u.w. a aae. SOC1Al SKUlIiY NUWER USUwI OCCUYATIOcr ,u~~ .wo o~ v~a w•.t o~~~.w .ys~ w KWO Of WSWESS Ot Wp11STtY` • OCC~~aeO w ~OUwG uN. lvE~. a1~ [10 ~ ~ . ni . Gnry ~ei.w..ct i~roq 17 ~ii' .-lI~~IJ % 1 IL -t- - - ~ ~1L i; " ~C-: ~ `O:'•?: ~ "Di1~~O"'- 1tESWENCE-Sf~tE COUHTr G11r, TOwri.,02 lOCw7eOn +sbe car .~m STtEEi ~Np HWr~ER L.,~ - ~ ~ SrttN~ r~s M w0 ~ IN_ ~li''~:C?~1 INiI. T.!'~ ~ i14 `~~l_",. , . ~Nf `~PC IIt~''lr:^ _ - •n+ ' iAinER-JV~/NE ~~4~ r~0p.t ui: j MOihE4-MA1QfN NAMf ~~rs~ ' +wa! W~ 'J l ~~~1 .1 :~i1' ~ ^ {f ~ ~ ~7l L.~1 ~l~ 1_ ` INtORMAHi-MAMf ` titwKU:G wA'.~ESS ismti o~ ~.r.o. .a . te. O~ rovr.., ar.~t. iri Vr~i~ :il~~;lci%' _ .~cl:;~?' ~:n~- :t:ir, j~ n- _ _ l r~er oun~ wws uusfo ~r: FNrea oN. r aNt Gtl:Sf Kf LYYf fOY Ie). (AL .tNQ (c!I .rr~u~:~wn ...:t.... ~fM(!ti O1+Z(t ~ti0 Ol~Tw .rwo~.n cwu ,a~ l~.a Q ~ cv.i~?t.~ C.~ ` , ~ -G~.. i fOMO~t~JMf. ~f ~~n. , • _ \ x~~ ~ ( ~ ~ ~IIIMICM o..i .~,e w lel ~ ti 1 M ' rrl0~~1f C~Yff b1, ~ W~ ro. « af ~ CMqlOVtwCt y: f7~1~MG Iw~ VMO~~• ~ \~~MG C~Vi! \~it ' ~ ?Mi Y. OTMEt SIGHYICANT COMDITIONS, cp.wno~.s t~'e~,rr..w *o a[.r. ~a~ »oi ~u.reo io t.us~ e~ven u+ rur ~ w~ ~T~ IF YES wut ~~e~~»es coti~ . +~ris pa~.g1 s.ot~~o ~r. ot~~a+~.u.o c~ru h~ /v v o. oe•~w ItM ~!•a4oW ! wCUDFM. SuKWE O~ DA W1UiY ...a.~.. a.., ~t.e 't+J..r MOW IN3UYY OCCUi~ED ~ wrE~ wna w~w,~~. r•~~ ~ o~ r~n .r~~ ~ r,~+~u~, ae vocrcwuao. ioo~h' ' ~ M iY IN1U~~ Af WOlK ItACE Of WJURY.r ..o..e, ..u, uae[i, s.voa~, ; ~p~w7~Gv , sr.ea o~ ~.r.o. ..o_, e~n o¦ ~or.., a~.n ~ ~yIlC~n ~~fM+O~ pnK! MCG.,lK. IYK~i~~ 7W ' 70~ ,'::~g CERt~fiG?AON- .a+r« wr •i.~ . .,a.-~ c.. '.w :.~s~ s.~r ~~.,~~.e. u~n o.. i ao/n~a.ar v~ir w ?M11K1?N: ~ ~TO ~ : .?r.M O~r rtY '{ppi ~ p~.~. DEAfn pCCY~RF •i y ~ ~ ~t~i: ~~RIrMlD fw! ` j j Mu•, O~'r~ ~~.O~~F.IGf. G.:l 7t~ o~ce.uo ~w. ~C ~ _--~?:a ~ • i", l 1 ~ ~7ti l ~ ~ / ' ~ 1~~ ~ 1 ~ I7t. ~ ~1.~ M ro r.~ e...se~ai ~r.r~o CE~TYKwiqN-MEO~CwI Etw~uNft OR CORONER, w. .~t •.~.s a r~ .w~~~ w ci.:.. . r•~ or:~- +i ~..a ?.a.wwc~o o~.o t.arw.~o~ a~we wo• .w/o~ rw sn~sr~c.~~o... w..w~., +a+~w wr ,t.i .ou¦ ~ ' Dl~M "CY~tlO 01+ M! ~MO OYt q Mt C~yS1~S~ St~f~O. 71 \ .,y CE~Ii iF - uw ~ .~o~.~ t~`_ ' $t~:raT,,; ~ i ' M ` Ea ee a r.e DwTE S~GtaEO T~. o.•, ~b ` \ ~ ~ ~ ` S J ~ ` ' t _.~~r~:~.-` t ~ MAY -CfR ~ ++ui~ oa ~~.'c w. ~ c~n o~ w~.r.. ~h ` j : ~ ' ~ l ~,/ti%.` `~~.~1(~ CRf~iqN. ~(MOVAL CfMETi4~ OR U+FtiuTOiY-rww.c i ~pUTrON c.n o~ w~... wr[ ~ ta L: ~ 1 ' :s? : ~ , - • - - ~ - - ~ ti~ - - .y _ _ . _ _ : OATE ~.o~nw, o.~, n.~ ~ FUnEQAI nOME-t`wartF nrtil .x?D.ESS , su~n oa o. .o., an w ro++w, sr.re, rv ~ " ~ 7M ' ~ ' ' - - n j ~r : - ~ _ _ - _ . . . ~ '~`n. ~ 1`~7~ ~ Y• f61Q fUNf ~'~/yyq~~~ 3[3~~+'+ -J..~Y-7:~2: ~ D~TF [fCE~rED IOCY ~E4~STtw~ ^ n... iYlG ~ } ~~~Ir~ " J - ~ a~: ::s :.•.....i.a ~74 ^ ~ JLioO FIlEO ~kL~ ft CORQEO ST.IUCtE CO~MTY FI,A. ROCER POITRAS - ~ hereby c~rtify this ro be a true and cor:cet co~;j c~ Lr~.:i CIEttK Ct :4UIT COUR~ _ - R~istr.;rs record on file in the St. lucie Cou~ty H~s~::~ RECQR~~ vE~{i1EU~~ ' me~i at Fort P~eru, F~Olidi. ,l~.1T i`l i~ PM'~L f r ( Waming: Not va:id unless ~aised seat o` s?:.: S~. iwi~ r + " Counry liea~th Department ~s aff~~ced.) p~ . G . ,t • . . ~ d * ~ N. D. MILLER. M. D. `'~'L .•j % ty Health Off~cer « :r_., . . •i ~ . -7 / ~.0,~. ~ - ~ • ~ ` ~ApU1~/ ~OCi~ ~'OCistr:.f s BOOIi ~+V ~ PAGf ~~~~7 ~ ~-~~~1 - ` W~ . ~ _ - .