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HomeMy WebLinkAbout3062 - ~ ' - fi~EO a~~ ~EC~~oEG - sT ~uc~~ :c~UwTr FU. ~~~c~~' PO~~ ~ =•)ITRAS 0 p - CLE9K , .:.ut: ~OURT ~ ' 9FCQ? ` ' c ~~p ~Y3Vps o~~ 3~ ~H ~7z ::.is De- iTwT[ eowna o~ N~w~Yx C~. C 1:r i~.:=. Ot= DEATi-i • BUREAU OF VITAL Y7AT147ICY STATE FIIC KO. ••,;•i F.T.O~:D:i 2~2 ord .Aen p~; 7H \O pEGISTRAq~S /:0 ,ro~~rlr eceeuteJ 1. ~UCC OL D[ATM ,tGJ:: AJ. I2. blUAL R[fIGCACC~1~4.~IrrMbW !!.wd.1r.~ Rr./..~k~~~l~ww) COUnT~ • S:''~ S. C Tv .^a .•I1 St. Lucie ~ co-G25 :lo:ida i.uc-e e. pi.c.a !w p~~- A. C~TY.70~s.0AaAC~iqw c. ~.a.~ u% :.i~7.. c. :.:Y. Ti.wN.G.I ~OC~TW+r ~t. .S aiS•:d~:E ~~~~st ~ .nS _f '.7Y :w.7ir ~ i ~wS.DE UTY l~r:tst r,,.. rt. Pierce Y~S:~ : t. Pierca ~cs~ ,.o; w~ri Ci jl/Mt ~w ~ayvd. Ju[ diua ~,tGrmi u d. ZTPC(7 ~JJNLSS • . . M~~Sa~T~: p11 ` u.STRuTAw gt. Pierce Z•:a.:.o. Eos~;t:1 1010 ~ve. H 3~t~~tt o? Pi.~! Y.:::t La.t i? o.-t Newta 4aJ Ytv OtC[AtCO ~r.,...~.~,~~ J~es B. T_ylo:- +;~;,T» :,ay 8~ 19~8 S. SCn i CO:WI OR Iu1CF 7 ~w~x.(;. ~ AiYIM MAwA.CC 8 O~it Os a,p7h : 9 •G[ i!R :~ap ~ e..'.Fr + ru~ ~ J ~.~(a raS ~ ~ ~ ~ 1 1H O ~Y(~[~/I N~V~. 1 D~M H~v~ ''Mu~. . r t t• r..31A ' ~0 O w:a:.w.o.~ ca-cc ~:CV• 7 g ' 77 ~ , . ~ ~ • ; ~ , yl~lp2~ iY. ~SwIO::~~~TqwICaN~~~~/rsr~~a~r :GG w~wpGii.SaCSSJA.nJ.~STAY':i.•..ATns.4CLf~strwJartY~c~r~tr~1 12 4ii2[sOf~tiTCq.wif~n ~StA y~r- ~.nc]tiM(~~Y'N[~y7~/r.r~ewi/~atvef~~ -•~•p~ Co:.~.on I.abor Farw usr.d • Caorgia ~ U.S.~. O3~CY l~k I1 iATn[N'S MY[ ~i<. rO'niA'S YA~3iA MY( o? ~s~••~a~•~ Jn.tios Oscar Ta lor i Liz:.ta G:z.'~aa ; t6 SXU1: S(CyR~T11 w0 17 IN/ORMAN L?tG/4?TY1tL A({rt~~ ~ ~ /1 E 20~:-03-223~ ~ar,., ~_!i ///~j '~-%-.r ,l_-C~c~C'_^ ~-T~,...~ i cwusc o~ DiATN t~rr. - lun~~al ~ /~~tnrw` :~rr/ef~r. ~•..v.ls..~' f /w:[RY~.iGA.[~ ~ d 1 r~ c t~ t ~~~T i p(~TM wAS CA.;~Y9 ~r: • ! //I O~SLT iwD 0[~Tw i ~u~t f13• ~ IYM[WATL CA1/X I~l ~ ! /I .J j tA• e~~- / ` ~ tifle~t• I~~';• j~;.• /i ~ r i 1 i : •SC\ cp• CcntYwt~.~/~n7. } p~E TO ldi ~ ?~~!";L?'11'~~-,~'/ • s ~.4~:1 ~art rqj fa ~ ~ - ~ - 1 O l • 1 Y+~tf CiYH ~ ~ t• lsv~r +tu~~~ ~le ¦~5~~. , ~q a T il~u~ [~w[ lut. a.E TO (ri _ " 110Yr~e~~l ~ ?ww7 u. Orw[~ S+cwu,wi Cp,~rUws tcwn.s~,',w~ ro ::Z~'n u..: A:.: k~.AiI~ IG :w~ :'[Ar~W Q$[/1X CCNFiUh G~YLN J~ ?Y17 I~t) . M~5 Au:GIjY a E a~~ A~~t4 ~ I[Fipnw[D7 ~ res? w~ or e.rer. S .~ilw ~a -~•~Tw.?ol , x'd D[SC~.:DE ~Jw .n:,.RV ~C~FiiG (~4:P AYVf ~JI~jW/ il~ PYI I M POI L~~Yfs 1~.) ~ d 7 _ ~COufAi 54~C.G[ hJ~iG:.i ~ ~ •1~~~~~- v ? ? C ( ee •f ~ . ~ 2Gt Tw[ Os Il~sr M~wt~. lh~. ?i~r ~wwr c D- 4 ~ } ~ Z:.~J ~nJU1111 OCCJANiJ 1'.Dt I.~:i Of .^.~pr ~r. '~n N: cu t:w. i x/ GTY. :Ow~. G7~ ~C<AiA~ COU1~Tt ST11TC wn~:[ AT bpt w.U~[ r~ /4•~. ladary. ~:~rN, c'J.:~ wG).. d:.: ~ 'wJNK ~ ~T 7sOaK ~ ~ ~ 2 i ~ - I~f e d~d fA~ d~e~s •d rom c ,!o •nd l~~t ~~r A m~Iir~ oA :ti; D~~ hbeeul~~d ~f ~~7n ~ ~ y~-~~ m on tAe d~b aaateJ ~Aow.- ~nd to tA~ Mst o! m~ wnorl~dQ~. Gom ~A~ uu~~a ~t~Nd. ~ ?Il ?t~~s l~ ~ TY ;L.~r~rr.t?:~. S wLJa.SS •t• to D• / (12t.:d7ES.GwfG ~~•,~•t• • G • ~ 4 '!G':i~j : ort ?ierce, FIo: ~da ~ 5~13~08 ~ .cc~r.u, - 2~a e.:,:...tn~..Taw. 2]0 owrt 2i::~•~co:ccw~c.wroa:a.~~-car 23.: lOi.~TAniCYl.l~v~.Mtrr~t:r~ CSt~a~ ~ a(rJ I~Ypr[~(/1 I ? i ~ :,ur~.~ - 19 - 6$ ; .1 r.a Grovo Ce~ ets:,~ ~ :'i. °ierce, ?2orida Y.9. f613 2< ~w/~n~~L Aai/{ 7G~ S S~Gw uME ?J~11i55 Ai~~. ~x~~ qfG ZS. R G~STI1Aq~5 S~r~A~{irAE r iler.1G66 ~',1i i//•' ~ ^ti• p~c'3:C2~~: • ' ~3f ,7~~ ~ • //~..~/~~~LGtCt.~/N•~C,• I here'~y oa-tify this to bs a truc3 and corrett copy o.` Yra Lxal Re3istrars roxrd on fife in tfie St. Luc;o Coursty y.*a,yn p,~~x,~t - mGnt at Forf Ptefo@, Ffortda . •,.,,<<, ; (Wamir~: f~ot v~7id unlo;s raisEd seal of tha St. Ludo Y~~ . Counry Hea{th Oepanment is affixod.) , J~ f=_ N. D. MILLER, M. D. '.j' t~~ r t - : ~ • ^ County ttealth Ofticar d~ loctl 2a~istcer , i; • _ • . = ~ /Y~ -'i ~.i ~ C - L '-r-~t.• . ' ~r . :ts `j- j . ,~s _ Cr.` :1~ Ocpury t,ocel Rcairn . ` • 1 i l ' ~ ~ . s - ' ' . . ` ~ , ~ „ ~ . ~ BOON~V9 PACE 5~ _ ~ . _ _ _ ._a..s~:~