HomeMy WebLinkAbout0135 PR~FESSIONAL UCENSE 1fj r.1~~ 2~ti
7'o the Ckrk of the Circuit Court o( . . ~ i•~---.-.----.''5.~~1
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~lp,~ . ~AME Oi COU\"tY N.WE
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d...o! ~u~~,~.,,:~ Z~.__..-----... gnduatedat...~ttea:F_ 1+.LL~.:1~ 5~~. ..~~.~_!~4'.'~.~:~.~./X_!/l~date-•--~!=~-`•~....~1.6~L•--°-•°
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who, hrine dulv s~.orn, says, I am the person named in the foregoing 1'uense and the person named ia the diploma which I displ3yed
h t.~:r ~h~• ?.:..~mininq Roard, and am the lawf~l ~wsscssor of sarne. I have, before receiving thi~ license, rnmplied with all thc reqwre-
r.~~ cu ci~r craminar.on requicrd bp law: chat,~tw~i~y has bern paid for such license, cxoept t6e regulu iee paid by all applicanu, _
~nd ihat no fraud, misrepresentation, or mistike in any material rcgard wu cmpbyed by any ~c. or occurred in order that such Gcense
s}:•~uld br ¢rantcd. y/ ~j
~ ~ L Signcdl`rL.Yt..~'~...'`.'':!~'--- ..i~~...._./~...:-••-•-- .
Cm'VTY OF _ _~'w'"l~.`~" _ .
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ST.~TC OF _ ._..j F.-..~n'...~{l.LL!~!!___`~"' "
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Signed and swocn to brfpir m~ this......_.._.......... --_.._......day of........------•--..__ 19.~/
' /1` : . • Signature o[ Ol6cer.... \~~LV°--
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~ `j M~ Commission r~ires Sept. 30, 1972
~ , . ~ ~ '-3i - 71
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STATE OF FLORIDA ~ I, _lanl. t,_. Sartdi~ld Cierk of th- c~n~~t co~n
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Y ~!N=. in and for said Counq, do certity that_----iblvll~ S~s~1
3 - CnrNTI' OF.._ ~
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~ of.--- ~~a~~t~--_~!--------_-----._has this day registe~ed the forcgoing
Licenx and 4tGdavit in my o(fxe.
~TTIE$$: my hand and th~ scal of said Circuit Ccwrt at
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~ . f ~t~-- - ..day d----~ -~~---~tMb!l--- 19..~.
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