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HomeMy WebLinkAbout2961 . _ ~ ~ 260180 ~ C: :c~ :Cr^? i = DEAT:-2 Deyarl~.e.t ~i 11c~a{. e'.o Rc6.L:i.4ave javkc~ i:.~:>:uti :>F ttt.~t :it j CTATC tilC J:O. rrr~. ot rbHr iN : L O r. ' REGtSTRA~~S AO. ~~p i_::'.:.:::T.'T INK JfCfwSED-iv.wt Li 1'~.~.i:0[ fOl ~•~at ~..a jfa :~~ik Gi iiw:n . ro.~., a.r, .u~ ~ ::r.xr+c.s GRF.'I'T~ ~_~.RZ~ ~•:CCD '•^e^ai e~, Octobez 23, 1972 S6V2 . UCE ~r.~n. w.w0. ua~a.. r.w.r. I wG:-w~ ._.o.. ..oea , e., :.w!F ci i.:Tn .eOl7+y:~ O+ ~tA:n vt. ~ uKw ~ i~~u. i.a.~?~~ .r~a_ a.n i w.q .w . White ~0 ~ ~,~ov,23,i9I? St. Lucie G7Y, TOWN. OR ~OCATKN~ Of.t7M ..sa~ c n.-..n MOS).7w: 02 G'nFi :~.S:~:u~~Gn-hu.~i ~J Vi .w arr~, cn~ stau w wwi~ . : a.u.n ~~a o~ wo 1 , ~ Ft. Pierce Yes Pierce :~~e_r.,o~i~2~iospital ST~Tf OF 4i71+ ~ r ro~ r ~.t... wi qt~2Et. pi wnw: lJ,.~.:3Y T~i.ED, .`vc. ri,~i~;FJ: Su~V v4iG Sp~iSE r w1. On~ .u~O~w w1 ~ eowr.r.j w~ r:FO D..^it~o.vee..~ ! ~ :Iissouri USA ~ "Va~rzea Lea Wood ..~..«t~.,.o - .~•~a. u a.a. S~~u~+N NWJfa ' I~S~IAI OCfvfw7~pn; ~ u vE a~..s o~•v;,ra w..a o.•..~ .var O~ , Ru.,p p~S~,~u p~ y„~yS21Y oec.uua w ~ raa..o w~. e.t. a u r..:o ~ i : „ 453-03-5471 Waitress (Retired) Restaurant 2ES~iriCE-S:wfi COU~tt .C:2Y. i~wsr. pa ~;,Cw':Ox w+s~c~ c.n .,.n ,Sta(ti u.O r.u..~Et t~y r^lorida ~ St.T.ucie it, Pierce ~""`"~es 1~12 S. 28~h St. IN I~S ' :t: : 1~~ 1~~ iAinfl-NiWf ~~W rAal rll ~Ml~Sru2~M/tt'SfN.'VAML ~WI ~.Tk~ L~SI „ Unobtair.zble _ Unobtainable s WO:Mw?fT-t~u~F 'erw..~_~.'. wJ9]iSi ::-uu o~ .O. cm a•w., s~.n. ir. ~ Leo Wood 1712 S. 28th St., Ft.Pierce,Fla. 33~50 ?~tr Dtwsn wws u~st~ ar. ....c,....:. ~ ;iNlEi Gv:r Gr.F.:.~uSE rfa ..'.f iG1 fe~ (ol i~i: ~~~r.~~. owsa~ .w ca.-w t{. ~~+1+4 4~N V f ~ ! ~ , '•~Tw . ia~+T~x:~. ..'~"t O~~ ~ ~ .i ~~b~ ~~v 4 . co~sn.o.s. i . ~ r..t. c.n nst ~O (~1 /j 1r'; i: r--C~- 3-1 ...u~.rt cwf~ w., f «,jlO.ar.a: c~..a:`..~.a. a. . ~~.nw .»e~.- i ~ .o.o c Y8 YN ' i !r, , ~ ?MT Y. OTNE~ SIGN:iKurT CW..7.T4n5: eo..a:.u.s :w~.~.r...:, uup ea.w .Or uu_ta w t+YSa e..~w A1J~0?S~ i:f ~'ES r1~e ~...w..4s ew- - ~~ns u +o~ • s+o~ua upa~:..wo c..s~ ! c~ ot.r. ~IM /j/ n ±S1a ii~..,,o'•. wCGLe~:. S..,f:Jt Qi~~7'F~L2y .~u.~., aar, n.~r :N::JQ ~ nCW tl~J~ifY OGCI~R1fL ~ ewr~....ny W~.urn r.~t . M~.~~ e~r ~•:.~~C.Ja. Oi WDti ,ay:~l0 ' ~;,,,~.,r. ; i'' 'r.. M ':1f tnF:I~ wT WO~[ ~ aNCF GF u.:~.:r +o.i. ua.~+, .._i.:+~, ; iOCwT:Cn : sn~~~ o. ~.r a. .o.. un u ~crw. s~.n ~ ~art4n n~ pa woi •p.r.p ry4.~K ~s+ic.~~ _'7. ' ~ 1N. ~ T ; _ CEY.:f~wT10N- wa. w. n.~ ° .u.~. re.. ~..s~ s.. .../..u d. ~~O/i.0..01 o[M W•, swtSK~•..: !O ~ .~G~~. a~r nu ~00~ ~~q~ M~s. , ~pY~ GCCYii( _ ~ ~t ~..G. G~ +~e ~ .+a. w ~~s. +.r,ers~o n.t . . : • ....-a~t~.. :'a wr~.:~s a~ ~I~}/L."l.yi:.- ;70 ' i~i~„ ~..~c::t-L~/ tlt~ ~7t. i~M ca r..i wwsxz.~.~ ~ C:r:u::wi.Or+-A+FD~Cw: EXw~+.AFi 'vA C'viGVEI. c. u.r .c~. u c:..~ c.c~~.. ..o..a..cu oa.s l~+rw~t4+G M WT ~W/O~ tM ?~r~l'~G~:L... ~w Gr.~.:w.. ~ ~.O.~~w O~~ ~Ge~ ~ :l~fw KCM+~~ O~ wi wq ~wi OM b TM 4~S~.L S~~~f~ . ~ Gi.i.FKi- ~ _ - - M 7 : ' . ~!~.wi ~na w•.,.n S~'v.~w:,,iE c~uu w ra.~ DwTE S.~iO ~ w•., o.•, •w M 1A J "•7-_'.'i~-~LC•.: %`~~:`r. / C , ' 1 1 . C !k ~ ~\t ~ I ru,.u.GWGtESS-:fa:.•Ka .-y""` .'.o~-"c~..', - s:.r~ i.,~_"~ . 7%+ i / l ? i C'i • ' ! .~c~ p i„~.u. C:E~M.t+Jra. af.~Ovwl ,C&.;:c~r G<:.:r...::.:r~nwi ~ ,~.^.Cw:~Gn un o. w+.. ~ +~ec.n, ~ 3urial ~:~.Hillcrest Xem. G~r.s. Ft. Pierce Florida ~ ~ G~i: . ~.a~m, a.~. .w ~ ~ F~~t~a: n:: vf= ..:.vc ~~J ~uLZ~S . sr.:.t o• s...a +o.. c.:. a• t0,•~, sr.,~. cv ~ ` :W-_~.'\Qy-.-L.._~._Z ,~~RPT D:"\i:i~.i~Y.CtiiEt9~1 r:. 7~h St. Ft.Pierce,r^_a.33450 Y. 5.46i2 F1.Vc.1A13.^.ECf02 T' ~_G --_~-S.:ru-~;..c r ' ~ aar[ ~.ce:~:~ ar cc.Ca. uai:rr. r~` Rar. 19T0 ~;y /'/i ~J~~~, i /~L~~ 1~~:~n./ 7/r c_:( ~~2.9~'~v [•iiC. ~ Fs~'A~'OV2.TLk,:n 1I~ ~ 1 ~72 . ; . zso~.~o ' FIIED A'1Q fcECOR0E0 i ST.IUC~E r,ay.yT11 FLA. RGGE~ .•-~~iiR~S CIEFK ;,Ii:~:UiT COURT ; t heroby oortify this to bs a frue and Corract copy aF tta tocel pf~OF ~ Vf~ r~ , i%~~ ; Registra(s reoord or~ file !n tl~e St. lutle County Hoahfi Depart- ' b~ ~ i ment et Fort Pierce, Floride. J~~ 3i z 38 ~~'73 " • r? ~ . = ` (Vllarning: hot valid unle:s nisod scal of the St. lucio " • ~ w s~; ~ County Health Qepartment is affixed.) ' ' ~ ~ ~ ~ _ N. D. MILLER, M. D. G~ l fQ i, ~ : Cou Hea(th Officer b locel egistrar ~ ~~;~,~5 - ~/r~~ ~ ~ /A/ • • ~ ..t~.~1{\~\ V~ . Oeti DeO~M totsl Reai~r.~r• / ~ i ~ 3~1~K 2~V °P~;t 23Ur ~ - - - -