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'~1,~ 1974 B~ 901 N. 7th St Ft. Pieroe Florida 33~15
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t~~.1010 L~ 7~. '
"I hereby certify the above to be a true and correct copy ~
of the local registrar•s record on file in the Indian River
~ ~
County Health Department at Vero Beach, Florida."
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This is not valid unless the raised seal of the Indian
~ River County Health Department is affixed.
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_\loS..''••••, i. , ST.tUG« _i~'~AS~
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c1• aE~~~:,~. ~EF~ z~~~' unty Health Dir. , i.ocal Reg.
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s R+c~~VB~ DePuty Registrar ~
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