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HomeMy WebLinkAbout0978 258'79'~ `f . CERTIFlCATE OF DE ' ~'H I)tpadw?a! nl Ik~~1F~ u~al {2.1., ti~e ~e«i~e~ RAT[ FILC NO._ ~~~~~~~•~y FLORIDA T~?t.`~GR ~?:N1 IN ws~uwvnuo.rn... . REf•16TI~AR•S N7 ~ltN N~tif INK Y( t9:~?Ot lOt JlCfaeEU---rr~E rwe:~ ~~a~ ~t ~w1E W OfAtei .••.:..rw, o.., ' ~ ~iarie E. Day Fema2e , Julti~ ?.6, 19?1 . - . fACE +~:~e. w~Gr~. ~w~K~r ~w~.M, AGE-..f~ +r^~~ ~u..ot~ ~ w• D~Tf Oi ~i~M .+o..m, 0~~. CQuNtt Oi OE~,IH !K. 1 YlCY~ • N~M ~.e.n~ :.o~. w.i wows ..a.~ ~ , rlhi te '~4 ,,`=,pe t . 29 ,1896 Bror~nr 3 C11Y, iOwN. O! tOCA1lON OF pEAM .rwe e~n .rJS1=fAl O~ OtNE~ rrSl~lUtMJN-w?vE , u.qt iw ~nwu. ~r.e s~ai~ .w wwv~~ ~ ~O sr~:~. •es w »o Ho11Y~•ood yee I~rier~ori 31 Hos~it~ 1 - t - - -------T- - St~i( p ~ttiN ~ w«or u t a., nua UTIItH O'f wr1Ai Cp{R~Tt~ (MA,Rt:EO. HEvER M~[RtED. SiltvrvUVG SqUSE ~N ~.~q. oni .uwe~ wu.i ~ taw~n~ ~ wWOwED, dvORCED ~ v~cr~ ~ ~~:e~. Jer3eLL . U. S.A. `1~._I.iarriec~ He:rbert C. D~y ~+e~i oece.ses u.ro et.a. 50:~~1 SECUt~tt M1MlEf USU~I OCCWwiqH . u.e a.~.o o. •oaa oo..e ar~w rou w KINp Of WSwESS O! H+DUSIR'! J:~U~II. tV ~~~+G l~'f. I~IN f~n~~0 ,t 141-24-9201 Nouse:vife „ Or:n Ho~e •c^:•"Oi ckS~Ofr~:f-3tATF C01:t~TY ~IfY, tOWN. pR lOCwtlpN wvw un w•~a St~EEt wN0 NU?~tER L..,.~ ~s?u~n •ei o~ ,,,oT---- ~lorida ?~ro:~JBrd ~a Hollv:~:ood ves 2 00 F~rk Laiie i~ltif:--ti~vE .~~s~ ..,o~u us~ irOTHE4-wuWfN NwE ~.~sr ~o~.r us~ „ Not Available Idot Avai1~:31e . Ir~ttO~wwYt-?+uwE wuR+~tG ~DL+ESS ~»,ii~ or ~.a ..o. en. w ro~... v.~e. au~ Herbert C. Day 2300 Fark I,ar~e. Nolly~load, Flo:.•ida rwer ~ OE/tM wwS C~USED ~Y (ENiER Or~tY OhE C~uii t.i 11NF f~jR ~O. ~b}_ AhJ ~c?i qr.~fr a+f~~ ..a et~r~ j~ r~O~~tt C~v11 - ta! ~2~/Nd~LIR Q~ L?/~~"r~ rrl ~~lT J~~ r 1LiC~:J!3 S , • • ..U.u(~.Ca O~ to~w~~or~. u~.n, I. f'~ 1_l ~IT ~ Y~ ^ U rMICN 4~~! f~f~ f0 I,~ ( ~ I U II * ~rrtOt~If C~VS~ 101, D.,l IO, ~ CO~SlJJlrC! M if~t~qG ~Mf Vw01~- t~~uG CW{i ~~t/ - •wt`• f- OiNER SK',NIi1CANi ~pNrJfT~JNS: ~~~~o..s cwnwur.«~ q o~.r.~ w* ,.ot ~euno ro uvtt a~.e« w rae~ +~oi AUTO?5~ IF rES ~+i•i ~ ~~as c r+ NV ~~r ~ns M»o~ s~ou~o c~~u..~.,,..: :.._s• w a~.T~ th Y10 ep Vnb.:e•~I wCG~f+~.•. S4~C~7F Ot~'7 D'wi i WIURY ~.ontw. 0.•. te.~~ ?~OU4 MC+nKAE. Qt IXa: EiELatwfO ~ MOW INIURY OCCUtREO ~~~Ttt w.evr£ or .wiu~. ~w r•~t . o~ r.n .~~r ~ ~ 1r1 706 . !l4 M :Od 11ilUtf Ai wpltK ?uCE Af :wuRy +o..e, s~~en, r,n.n. ~p~~TiON ~ lT~((t O~ ! I 0. MO-. C~if iO~N~ s•.n ~ unc.nrne~++o~ WnUYOS.fK *lMC~n~ . 70~ 2q ?0~ CFRiff~f~iM~- ..o++~w o~. n.~ ~ ..a..n. e.~ .r.~ .»o ust s... .~.rtin a. ~ ~1:,.~.n* .~.~.:.rlo~~*.. oCtu~~rt+ .r • M +.R ~MriK~~r~: 10 ~+rn p.. n•~ ~ou, .rrn ot•rn - o.n. ..c r ~r7tn:tD TM{ 1 f 7 1' ) e '7 ~1 - 1~~ otcr.a•a.~o~ 30 7~ ?~'26 1 ~ ?i1 ~i~ o.... ¦..:...•o..: c. ' ' 71~ + 1 2I[ / T ~ • ~ ~ ~ ~ 7'e ! i `F J Ml 10 rnF _ a: : ••t±, . Ct+7~• U*:O?+-w.~~r~'wl fie•-r:r~Ea O~ CCVp?~fR o.. r.: ~.rs w•+t noo~ w w.n. re~ oeceoe..~ r~1 ~f0":.uwClO Dl~D ~a~.~~ l1~rr~.~•.;,~. O. -wf AD~ ~w~ r.~ 'w.l:`K.~•w~M. O+w,Ov. rOrrtM D~1 ~l~~ w0~• t._ C!~'w OC,~~~tp q+ Mf u+Y C~! ~O •M C~Ylt 1~ ST~7D j ' M M ~ 2„ ~ CEit•fu%-h.wF ,nn c~ ~ / M SK'strwTt~i oecrct cv nn[ • OATF S?G'vfD ..o.+rr. ,i.~• s tA_i~ ~ i~ : r t ' ~ !t S .r. r C j / ' ~:he ~ ~~'1: ~?ai,~.~~ M ~ ' 7 1 L - J/ Mu~:lv~. : ~D[MfSS--CEitr;~~? _~L i s~ae• o• ~ c ~ tin e~ • . f~. e -.i,-.----- t-~ ~ 1 ~ 3 ~ I; , ~ ;1 i 1 , ~ : ~=~1 ~ ~.:r ~ ~ -z ~ . .a - ~ , 6U~ut. CREr~AT•pt~, 4F~~C~w[ LE,wEttvr CQ CtiwtAiORr-n„eE ~ iCGwnCrr or. a r•~-... ;-.Tt ~ , . ~spc•n~ ~re~ ; : ~p , ~ ^ ~ ~ ~iu ~o~~ar_o Bzach z'1^ ~i~e ~ ~,?Tf - a icn ~ _.~a;~~~ ~ ~e-~~t~rK ~ + - ~ ~ ' -,y~ ..cN•r. o.+. •e.~~ iiJNF»t M^vME-. ~r+F ~~+D ~.._,ESS ~ s=a~n R ~ . o »o.. e~n oe ro~. sure. r~r ~ . ,r,•, . } c~~ ~n. ;~adlin~; ~ou 1 ~ix~•e t- ~ _~t ~~r 28 1 1 Hr; . . ~ ~ z-,-:•~~o~~ . _ 1 ~I /r• , lF~j Svh!+~t CiECTOi-S:vNali:i~ ktGtS~:~1A_-$,•~ti~7~4E ' / ~ ^r~!e tete~.c=`ar :.`C~i +E;.~i'.~a RPV. aYlt ' f_ ' 1 ~ - I , o:.I. . . ~ . 7N i -ir_~~ %t -C'x~.r ~ %r. , 2 ' . .sc 7"%/~ 2:. ~ 2s0 J.•~J_t_•.! 1 ~ j . ~i i - ~ ~ ' • . ~ _ • - CERTIF'I~'D CCPY _ . { I hereby certif~ the above ta he a true and correct copy of the I.aca~ • ~ .Registrar's record en file in the Bro:rard County iiealth Depart~ ent a!: s Fort Lauderdale~ Florida. ~ • ~ ~ (l~tara;nd;~=-;tnat..kal;d uiiless ~rai~ed seal of the Broward County Health 2~'79''~ - bepa4~~~.:n:; is affix~~;.) - - . • • '?~?:;7~f ~ " riLFD AN~ R~CGR~?ED . r~ ~.f5 Ta flr . • . ' s . . . i ST. LUCIE ~OL~NTY-FIA. ~ _ ,,I~.<.~r • ~ j~ Rr.Ci ~ ?Gi?RAs ` ~ " _ ~ - '-.ce~;.=., ':C~'li CQi1RT s N. .j~~ ~ Coun~y iiealtn Gf:~ca?'` a :3 :.ocal : egistl~lGO~~~ Y~=~f~~o - ~y'~ - - ,`.~zc~ . - ~ 5Q • -.c.-.. ~r~.13 ` ` 3 . . . . - ' ~ ~/1~~,~% iC~,~ ..L4` .i ~ n Il is PN 73 - v' J ~ f . : ; ~ . . - ~ • Deputy Loc~,Ll j'c~ie~rar - F . ,F / jr ~ ! ~ ~ ~ ~ . . . . , . . . h: . _ . rt~