The URL can be used to link to this page

Home My WebLink About0869 CERT I F I ED COPY IFY THE C:pPY ~PRODUGED BELOW 70 BE A TRUE AND CORRECT ~ ~lNAL REGORD'~~Tl FILE IN THE BUREAU OF VITAL STATISTICS OF THE GEPAR~~~ O~,~iEALTH AND REHABILITATIVE SERVICES. DIVISION .CKSONV+ F~,~~LO~~! tu _ , ~ r, - " ! ~ iE SF~1L~ !~E 1~F ~RRIDA. OEPARTMENT OF HFl.LTH AND REi1ABILiTATIVE 1 HEAbTHYS•i~._, = ~ ~ O ~ • a.' ~ . r" j 4'• . . , J`j. 1 r~R ' C'~K_ , ~ ~ {V W~~~ ~_7M~ ~~Y'' . CN~Ef, BuRE4U OF ylTAL SiATIgTICS ~ F~Y~ ~~~~~--~t. ~LC! _ ~ a t~ :~.J'.. , . `y-. : . . ~tS` ~,~l~~ Q~ ;,y~ '~r,:. ;,.`f.s • : W ~~9 n I ~ ~ . O.o r-~ t~~:::....:.- . STATE REGISTRAR: DIpECTOR. DIYISION ~DF ~ ff 2 4~ 1"~~+ HEI~LTN - DEPARTMENT Oi HEALTH AND . ' +~Jt 1 "i , 1 ~ . . qENAB~L1iATIVE SERVICES < ; ~ w . - ~.~..~---~-~:~1- ~ - . . . . - -~rF+.-- , STATE OF___._ :.a~~_.___.____~ A FFIDA'~IT SS GOUNTY OF:_.Sr._._LUCIE.____~ ~ ~ ~ ~ ' being first duly s•r:orn says that he --a..._.s._..,1~......-?--'w--`~"---------•----- ~ - , ~ _ . • ~ ^014' ,,.,.E~: 1~ lfl'_:S ~ attended the birth of--------- - j . J1 - - ~ on the______.._~.~~ .day of_... :_IIe .......................19 2~.and that the following errors ' ~ appear on crigir.al certificate No..__..1Cu18__ _ _ ~ Voltu~e No..____=%`'.. _ ~,a-~:; cr ~~:~;a is s~o~: $s =.~..~vi,~ ~~~_,:t :~~L~.~; >.::_.:L°: _t\illLL tiZ :fl:.lil'~'.7• of °3LI1~. sro•r. as -~.:~":Z:: S??~_•._'~Y iILLLt. : a:.. .:_._;i~~ C£ - .--T ` I l ~ l.! J.~'1.._J• This affidavit is ~ade for t2:e purpose of correcting the above nar~ed errors in CertiPicate hTo.___._1C,G1'' nrr~ . Vo2t~e No....__..~,~.--•-----•--------.. The folla~ing should appear which is true and eorrect:- --8+"r.^. O.° CL1I~d - °::aroi3 ~yGZ^,°y .i' ~11fl -iS° _ ~T~ c`' n~r - ':.d ~.:r.d ~,rd~~3- -:il? i _.:s" ~~~i (Signed)--- SAOrn to befare ~e and su~scribed in my ; S E A L presence, this_.$~~.~.__day of ~'eCe~ibeT_..__ ! nineteen r~HYed a d forty.-t_;•:o_________________ , . ~ . ` riot"a"ry u Iic" ~S~a t"e"'"t5~`""FIb"r'i8a'~ ~""'Rry ~ Conmission ezp~xes: Sept. 11, 1944 . :~a. 140 Officiai Titler ~ . _ . . , _