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HomeMy WebLinkAbout0185 ~ 30~099 ~ . I~eaitl~ and F'a~a~.ililati~e Je~ic.. STATE FIL6 NG.' - ~xv?~xxv or ?ur~ F L O i~ . L n • y~F. Ot ?t:Ni it~ ~~~~uR~~~ REGI6TNAR•S 7~0. 1tIMAN1NT INK a~~~-N~f r~~ti~ rawi ..a~ SEE M1~3t00t F01 ~ SEx ~OwTE Of DEwiK ~+o..r.., o.., t~.~ . ~s;waa.s , •',ATTH~:I B~ni;C~ it::ale Apri ~ 2Q ~572 RACE w~ua. ••~¢w. uu~K.w www. AGE-~.1~ +••ou i.~.~ u~ou ~ e.• DATf OF ~tYM ~uo..rr, w~, ICOUNTY Of OfATM nc. ~ s?uu. r ~.~n.o.. ~.t.u. ..of. ~ w.s wo~~s ; .w. •e•~ ~ . :~7rite ,.74 „ ; ~~~~5? ::av 19 ~:2T'~ir. CITY. TOWN. W IOCATION Of OfwTH ~-aw~ ca+ ~r.n ?1pSflTA1 pi 07r~EY NSitTU.10?r- =r wo~ u. e.~wi~, a:•~ aiais uw ..we~ ~ ~ s.a..r ns o~ w s , ~ St~:a: t i,. ~es i,. ~:ar~ir. ::e;.?orial Hcsnita3 Q ~ STATE Oi WiM ~ u.O~ w ~.s w.r~ UT12fN Of WN~i COiiNiiY ~iiFD. D:FVfR ~RR.E~- D, ~SlNVNN:G SfO.lSE ~ u rua. cn~ r.wi. wy ~ ' town•~ ~W~WfD.D+~'O¢CfD~sntrr~ ~ \ OfVN~lS~DIwC! .;;evr Y~rk L'SA .~_a: r~~d t?~ Helen Calc +w~ wu.xo S«I/LL $FCUt1TY NU/+iER~USUAI OCCU?ATION ~ c..~ a+.a p.wa oo..i aw...o .war o~ KWO Of WSWFSS OII {NDUSTIY ~fi N pl~M . • OCCW~ID W ~MO Wl. ~1r~w U~lh~kD ~ ' ~~Or~-2~-0~ G ~?Iectriciar. ~lectric •O~f~"- tfSWfNCE-ST~if COUNIY CITY, TOwN. Ot IOGTiON i~«s~w cm .rm ST~EfT ~NO wUw4Et s?e`~~+r[sww~, F L~~ S't.L18T't'. .n.UT'2i ~~u~„O it~. i~.'l~i ~2aT.ll~a J~'riC'@.. ~~~lc~ricia ~•."iartir ~ FASME~-NAMf nw rouae ust ~ 7AOihfE~t-w4rJFN NwJV~ ~NSr .uowe usr „ yir:cer.t Lo Biance „ Josephir.e Para~cre . IHfOiMANi-HM~E MAOITxj AGL~[ESS 11T~(lT p~ ~./.O. ti0.. un a ro~r.,, u.n. ar. Hele^ Biar_co ow~e 3 Poir:ciar.a Garder.s, S~uar~ ~ ~~t pFA1M WAS GUSED t1f: ;EN7ER OrvtY O/~i GtUSf Kt iWf fOf (o). (b~ wND c; ~i~„~ w o;,i~i .,;y a T~ ' rrl~.~N C~~H • . ' , v ~ G~'L',J~L "~ILJ STLIUC ,~'{,UL•lj1A?S ~A. ` 4~. j'1i~~ t~ , ..~ww»ci o.. :~t1i ~ ~ t ~v~~„o... .M. j r~ ~ 5 ~ ~ : ~ ~ 6 ~-L''~,.1~:1 ~lit -~i!'-~i ~ ~.l~ ; .~w~c~ o.re ns~ ra ( ) ' ' rrlDl~:! C~Ylt 101, wt IO.O~ ~l.4 CO~+S~W~MCI f ~t~i1MO 1M~ YNYl~- ' i ~11M0 C~Yl! l~lt ~ Mar I IZ 361~H'T5 ,~'099 ~ i AUfOISY Ii YES .+~~e r~.a...os ce~~ ~ IA4i M. OiMEt I1Hi CONW11pN~~ cowa~u.t tolce~utu.e ~O u.rw ~j ~aOt~tfJT[D t0 UY3~ 4MM r.n ~~s~ I~~es d r.0~ ~ 5:7~~17 IM p(~lt~~w~wG 4Yli i ~~nt~/'.~ v~1"-~~/' ''~`-J ~t~ r3 G~A ourw ! ~r.~p;~l i.U~DfNi, SUiCtDf WipA~~~ ~.o..:w, y~, n•~. MC~UR : MOW iNIUAY OCCIRRED ~ erau .urwt w~~iu~~ n. ~,.n ~ Oa r.er u, r.w u. ; iqr~,C~pE, pR uNpEiEWUVEO ~ ~1 ~ 4 I:s ~ ~ M xe IHJU[Y AT WO2K . KACE OF W1URY ~f ~W~.~. ~~~a. Stplt. ~Ktpt. ~ ~~wt~On { fi~ll~ O~ ~~.D. ~J., Cllf O~ ~O~M. lt~Tf . ~ ~ snan ~lf M MOI ~pp~ p~.., ~K I SINNT ~ ~ 17a ~ ~ CERTY:UT1pN- ..o..rw p~r ° rowa. o.r rtu 1 u+o ~.sr s..r wr!we~ ~~i~l Or~ ;~.irO/4~D w0~ ~Nr+ tW' O[wTn OCCuuEO r~~ r,,.t[. O+ *~e /M~SK~6NC ~j ~ rO~.rw O~r ttu ;~OOr ~~10 DI~M. ~~i.OYai D~q. I~wG. !O M[ ?Ii' ~ ~ ~RFnD(D fwt ~~yy~' Z - ~ TO } / Y ' !f G f ~ ~ GI r~ (rq~rtlOGF. Du~ 1~• o~u.seo no+~v-/'/•~ ~ l 'Y~ r~ ~ ;1ie;,?;~''~ ~ Y ~tU 7t. L ~M. ~o n~e c..xs, sr.re~ CECTRIGT~-h~FDKA2 EXAwr+ER OR COROr~iQ. o. t~~i~s a r.r oo~. or u.u ~~~e ou~oi»r .~.s •~a.a:+.uo ouo t~..w.r~o~+ a nY wo. u.r/o~ ~w wreft.e.r+o«. .w o~r.w«. ~ +.o~+rw wr e.~ ..p„~ ~ oe.rw oeeaweo a+ w wn u.o ow ro rw~ eaus~~s~ ir•qo ~ ~y ry^ y y~ ~ ~M 1i~ ; 72~ ~ ~ ~ iY ~ / tY~ 3~ / • M CEPTI/~,y~ vf mn Oa Jr~wn ~ / ; SKlNA~1iE ~~,/~~~u:l w ns~~ ~ DATE StG~.FD c.wwTH, o•., t 1H ~S~ ~C+. N ? :L i-.~~ ~ ~ ,'~~,-~v'v`r~ . ~1k ~i!.~. 2 ~ ~ a µwt;WG SS Cf yEKR s-y~~ o. ~ u rc ~ . s•.n r.. . :u ~ iif~Yi viri~ c ~~',!r~P. ,~~r~~/~' ~'i.~ ~~'~,~i /.J ? ~ i/ri ; ~WikZ, Ct[ 1~01t, fF~.?OYAI CEME7ERr Oi CiE+ae~iORY- ~ Ptc~n ~ ~ , ~ ':~'~`TfpN 4n o~ rpr» si.si ~ Re^~ov21 JS Cre~ atior Co ;,,,iiddie tlilla~e, P:e~a Ycrk - O~TE ~..ow+w, w~, .iu~ {FUAEQAI MONf-NAMF AND ADORESS • 1t~~t~ O~ ~.~.o tio., u+. o~ ro.+, s..re, t~? ~ " iw~.8ti" i, 1 72 `~s. Jor:r:5 :::rC?'8i ~O'?:? .G.ttlu^i't, t'~''ZCT'1C3& 33~ag1: ' Y. S. fE 12 ~W~+EQ~I DyiREC~- fUQf REG+StRwR-S:~.n~iukE o~~(; [cE~vc~ iec~i iio~si~•e _ e.~. 1970 ,H `"~(3+s ` -s --:,,Lr f.~~~ ~ur,. , „ r~ S ' ; f f . 1 r •f~J/~~ ' t ' . c ,~+'``,'~•1~. ~ .j. '•t~. 1 htreb certi tti:s to be a trtte and corroct co Y fY py of tho local ~ , ~ R~~strar's record o~ file in the Mortin Cour~ty HQa;th Go,~aR- ~ ~ ,-f _ : _ - . ~3 1 o~eni at Stuarl, `lOrida. ? ~ ' ~ ~ ; ~~JGfI:ll~: n.C! V.ii:Cf U!1~Ci5 fJl;~(J S~J~ O{ S:iC i/~dfS~tl ~ ~s+?~''r~ Caun:y Ha~l;h Dcp~,,.,._.it ~ ' ) ~ i.. 1 1.~ _ S JftiXCt]. ti ~ ~ . - ; ~`y'~"~` ft Ih. v. ~ r'.~~1!.~~. 1J1. D. _ ~ ~ ~~z' t%: ~~~s~~; Gc~r.:y ~~:;,tn Gi::cer E, Locat Re s;rar f ..s.t~,~ ~i ~ I ~ ~ x- ~ • xz~~ ~fo Dcputy toca{ Regisiror ~ B~~K239 P~GE 185 ~ ~ _ ~~~~_~~~W ~~A~W ~~X~ fin m , _1