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~ 1^.e:eby certify the above to be true and cor:ect co~y of the Local
Regietror'e record ~n file in the Broward County Heali:h ?epartment at~
~ F'ort 1,auderdale ~ Florida. `s :
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'~Karning:-.~~•3~~tj'v~~id~.unleae :aised aeal of the Broward County Health -
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~ s ,.•'beparta~en~~'~ie affixed. )
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`U JY' - 1 : :,'-~'~~~~',t ~.~f~~l; ti- . ~ -
W3o ~'j• ~1 F~~ County Health Officer and Local Regietrar
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SODG~~7 PAGf14~ Deputy Local Regietrar
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