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HomeMy WebLinkAbout0780 2'71.404 C 2'71404 _ Ci~• • 1!'~C.M! G ~CI'?w-~ 1~epul~eo~ ~•~Ia,aIIG u~d Ra~aE.iliulive Se~rices iTATi fIL[ HO. Iri~^~„~(~lµF~~~ FLORIDA qEGt6TRAR'S HO. T11?E. Ol ~R~NT IN ?tRMAN[M INK ~~p_H~ " ru~~ _ - w~ ~X OAtE Of DfAM ~ ro~tr, o•~, rt•~ ~ SE[ 11~110100[ i01 ¦S1lINi1~S ~ ? ~.•ii . r. . c•.1:. n'.. t. ~`l f~ ~ ~i'~~r.'~r.i-.nv. ~ i'. 1~„7? ~ACE vrwid. Mroq. u.uwu. ~.wuw. AGf-usr w+oe~ ~ re•e• u.ae~ ~ wr OwTE Of Wti11 ~ra.n~, o.~. COUNiIf Of OfATN ~ nt. ~ wun ~ waew~ ~~ws ~..os. e.rs rou~s ; n n i j R C`r ta n i~ 007~ ~ :T;~t:rn y~ '7i A. A ~ ' , tOwN. O! tOCw DEwTN wawr cn .r..n ?WS?~Twt Ot Oi?:Et NSTtiUi~Ow-N~wf ~r ~+w w uu~n. un siru .w .~u.w~ ~ i?tcu~ ~u oe wo '~i~l„'f p~ ~rn~ h. ~T'~S ~"r1- .,rr~ ~ („'~i1"~^1 ~ i 'T~~-:-i ~~i~ ~ STwTE Oi Mt7H ~a i+ot w v.~.~., w.rt Gi~2EN Of w1SAi COtJNTR~ w~RRtED. rIEVER MAR~EO. SN~vIVNG S~OUSE ~r vw. oin .r~w~w wwt ~ towa. ~ ~ MlIDOWEC. OivORCEO t wan ~ _ uwuusoti+a ~ ~ TT _~Y.~ n. -,'-i-: n r-?'.~n,-~ri--'+~ wwu ace.uo SOG~I SECWIi1? NlMNEt USt1M OCCWwT~Ot~ ~c+va ao.s a ra~ oa.~ ow~.w rosr a RwO OF WSR~IESS Ot wOttSTR1' uvfe. w N~t~ OCCValO w - ~Or~~O Wt. lrlM M~li~~W 1 . u.ww~~a..cne ~tn~'7~77_130r U~_ .~..~.-.,~:-.-r,~~ 11~. ';?--Z'1 i~.r.~ P~:ir-,•`,(.'-;~-.. ~eiwe.~cr rror ~arss~or. tESiOENGE-SiATE COUMT1f GiY. TOWN, OI! tOCAAON ~wsw~ cm awm STREEi AND NWr~E! ¦ y /VKN~~N M MO~ - • _ ' i~T ia ~'1 nri ^ in 1.~7^ i<? ~a ~'r~ n-..., n u~. Y?~- ia~(~'-'- ~ 7 fwrnElt-i+~u.t .w. rww us~ ~?oiHEe_pupEn N.u~tE .w. ..ww. wr ~ , ~ ts 7 t(?L' U. ~ WORw~wi-w~ME MAfIwG ~WDQESS ~snu~ a~.~.o. .w., un a w~.., arwn. tri ~ ' - - i l i~ C 1- i?i- i7 i p-.-... ~ ^ , ( - V~ ".~.ni-i~j ~ i n~..-.r.: r,- lA ?wRT DfwM WwS GUSEO ~11: ~EMfR awtY OnE Cw45F lfll trnlf fOt hb (bl ~ RA ur~ir~u o.~ia~i ..a w T+ li. w.~w'~ - . ,C! L~:~- .b'~lL~~ /Z - . . , COrN1~0~+1. ww?, L. / L C~ I( .e~tw o..~ ~~ae w ~ 1~1 i ~.r~s~.re c~~~e ~a. w~ so. w~s ~ c .~ce a: ft~flMO tM( YN~!!- ~ ~~1M0 C~VM US? Nt~t Y. OTMft K T CONWTIONS a+a*~o.a co..*wu~ww ~ .rw ~ r.q~ auno ~ t ust a~ h .~ti~ w+ AUTOKY Y YES .rtn ~~.+s~r.GS CO~+- i Y ~~ts s~ot~io u. wnw«~wc c.~sa ~~~C~- ' ' ~ ~ f ~~Lt' : ld iu : l . ~ ~ o..,. p.epoW~ 7 KC , OOE Ot ~ rp+iw. .~a•~ ~ MOUR MOW IWIURY OCCU~[f~ ~~~tt run~t u+wn ~a~ ?~at ~ oa ?.n u, w.. ~ HpMK,~Df; Ot ~p~DEiEWWfD I~Mf1 ~ 70~ 10~. M. Mi. INNtt AT wpRK /tACE Oi rtAJtY.* .or. r.i.., srrn. ~.c*on, lOCwnOrr ~ snen u a.~.~. »o.. an oe ~ovn., a.n ~ ~s?eu~.nso~..o~ owtirsc..~u_ ~wcn.~ Ib 7M ~ CEtTYKATrON- .~wi¦ re rw .a.n. o.. ~iu ...o uar s.r wrI¦e~ u~re o.. ~ ~prv. x.~ o[wrN Occuuto ~ m~ ?ucr. a+ .~e ?M~SKurL i~ ..wtn we *w 'DS ~wu~~ re. ~.n. *O s~t u~~ . ~t~a oi~ :uo %~~o.~. '9~?t7_71 10 -18-7 3 10-18-7 3 tu- - ~i~. i~~4"o n.i w u°~i`t:na CfltYKAT10N-MfOKwI EJ(AWNEf Ot CORONER: O.. rwe a.vs a r«~ o.pe. L~ iM{ OKlOlM7 V nowww.eo o.e ~u.wrtow or rw qdr aw/w twe r~vtsnwTO~+, w..r w~.Mi. ~ ~m ~ o~~ n~~ wu~ p~~M OCMtlP O~+ Mt M1! w0 W! ~O N~t 4VSF~f1 1~~1[O. ~ M 7I? M GEITtFiER-NAMF ~me u~a~n SrGNws xcu~ a rnu DwIE_SIG?+EO i+o~n., wr. ~i.~4 ~ 71~. ~ ~ I f/. . . Lc '7k. MA1lWG AOORESS-CE1t~ R unn w u.o. . un w ' i.r - ~ 802 Nort~ 7th Street ort Pierce, ~.orida ~"34 0 ~ ~URUI. CIFMATION. lEMOVAt CfMETFRY Ot CAEMATOR1f-NM~f - IOCATION w p.n. u.rf ~frKi/?~ _ . ~l ..s- "3; a-.~+-,n - ~ H~. ' tN. '~"~~~n =-n:~<. tk. ~fl DwTE * ~rwp~w. wr, rrw~~ /UNERwt MOntf-rv~tMf /uVD ~DDAfSS ~ snen'o~ ~.r.~. .a. cm w~owM, s»n. nr ~ Nf :\T ~~.T 7 C7 1 Q! 23~. i~'^ ~ r, c~ I! 7 r7 ~ii Q 1- y -J i n'ns~ p - . ~ Y. sb l•l , Ow1E 4CE~YlD ~t IOCAI lfGlihw~ f OR- ~ REGISTRAR-S~Gt~~1UtE • i . 24_ C%V . ~ 7 . R~r.19T0 ~ ~ ~ -I.II ~ l / tw / / r!' V / = l .f• ~ ` ~ ~ : fl~~o ~Ko ~~COaoEo S7. LUC1c COUMTY FIA. F.OCEA ?Q~7aAS 1 hemby cartify tfils to be a true er?d aorrcxt copy aF the Locat ~LERK C1F.;.U17 COURT Registrar's reoord on ~le in tfi~ St. Lucfe County Heahh Depert aECOR^ yE`~~F{ED ment et Fort Pierce, FlorJds. ~ ' , , . , . _ cw e~ ~~~~~~r'~ , . arni Not valid unlect raited scaf of the St. lucI~ ~ Z~ 9 04 • . d'- County Health Oep~rtment is aff~xed.) X r~~ `=~1. - N. D. h11llER, M. D. _ = " , .`~t County Health Officer & locet Registrar j ~ f~~=~ - • ~ ~ i~-~ ~ - ~,::r,;~:: . / ~ 1 i~ . ~ ~ j , - .a~ . ' ~ ~e~r~Y loce~ Reaiet.,~~ . . ~ , g'~+~~ 2~2 ~',~~E 780 - : _ ~ ; ~ t~~