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HomeMy WebLinkAbout2127 •rwT~ ~onwo o? M~u.rN ~ ~u~uu or vnw~ srwrme~ p L O A I D A rrwTS R~u~ No.-~~ si T NO. A~~Rw~y 1. ILAC[ N~tATN CODt NO. 2. YWAI w[SI~[MC[l~b.~~.rrMlw/ pi~riwt.a A~.MrNr~~iw.~r+) OOUN?11 rIFIEI~S a STAT[ ~ COyMT~ 1_ dTr. TOiNN. 011 I,QCATqw t. K ~LAtE Oi OEATN t. t~Tr. T0~1~. OR IACATfpM e. K ~ElIOE/KE .~s~oc cm ur~rn a~sroc arr uM~rn 8Ar PINES rc: ~a 3t. Peterab ~urc o~ ~ry w ts b.v~e.t. a.. aar.raw? t sneccT ~oaecss ~ mo YA CENTER 9?39 54th Averrue North 3. IMOIt N Ffrrt AfM~k Lw a??E ~lwt~ Dq Yw OF ~.t.r) . ourM ~ 3[x ~ CnL~ OR AAC[ 7. MARA~O~ 11EY[A MARRKO OATE Of M11TN Ai[ l/~ /t01 t Mi0[R RM A N Mf. 18~ x.~.. e .~oo.cc avo~cro YSY~l00[UTATIOM (04e t1~ Nwrt M~t la. RH100/ MlStM[SS011 IMO!lSTIIY 1!. MIITMK~Q (9'~!t o~Ntip eMt~t?/) 1. CR1m1 OI 111MT OOIM1~tr .•?w•~..r.r•«~war.••~•y••~?•n Leather Providence, Rhode Is II.S.d. 1 ~A11r~'S IMME ~ 1 Mp11QR'f M~pE~ AYI[ p8111 ril"e8CeI180 ~'aCA ~I1~1~ ~ . socuu~ sccu~m ~a. • Q L wAttJl~E. A wN.« E 2 2 10 T320 ASST. CHIfF REG bin ~A ~~~1 RECOROd 4 n. e~ ~r ~swtM [ «.?r s.... ~e. ~r /r. ta. t~~. ~ K~.1 tKrt~r~ ~cM ~ ~un ~ oun~ ~rns uuxo w~ aacr rwo ourM w~coatc csuu /y 's ST. LU:~£ :~~:N?Y f~A. ` a... ~/y•,~¦r. ~ m u~ ~L = - - _ -aaS ~ .Oor s~iwr - ~ ~ ~~f41 Me rNn- ou[ TO (d C~-"' ~ ~ t ~ ~ r~r.. r..r. rMT on~ s~wnum ta~rw~s ao~wn.w wo oun~ ~n usr ~cu~o ~ n~ . rt~~rcor ~ ~ ~ rag No O ~ 7M ~exere ~ow wnM~ oeeueiuo cr,we. s.r.n yiy.r ~ Pw t w h.t It y~Ys~ ~R) • ~CCIOEMT 3YICIOE NDMI[I~ x ? F ~r TIrE Cs Hwr Xwu~. D~p. Yar y wu~r s. w. ~ m1. rwq~r ottuiutto mr. rut[ as wwR~ 1~. r~rt M.w. mj tm. rarN. a~ t~ocnYw~ oouimr STAT[ 3 ; MNtE AT ~ nOT ~111t ~ fr*. /~1. ~bNf. ~ee Of~/-. dt.) F r011K AT MOAK z ~L ~ t~. ..e~f rlws~o....elroe~ ro 2 1~+.G~. ~~/y~1I/Jd~~lr7~Pf - DwtA oce~rrnl ~f ' 8~.. tM I~t~ ~r~t~d ~aw~: ~nd t~ tM Mst ol s~~ Rno~Ndp. /rom IM e~~Na ~f~f~f. - fISMAT{I,[~L (py~tt~N tm A00~lSS ~lt. OATE S1GlRO j~~t J~~~T VA CENTER. BAY PINES. FLA. 2/11 66 ~ 27. w+~+ti-e~u+ i]~. w 2]e. iurc or ecwert~r o~ e~cw~TO~r Z3/. LOGTION (Clf/. lw?s. M p~~/I (8t~ttl ~ =C~';: -Sb- ' W~~ila~ru Ceaetary St. Peteraburg, Fl~riia E ~ AO~I~, &a~ ~ 2S pATE 11EC0. ~ ~p~111 RE6. TIIM'S SIGMATYRE a _ 6 . ~ _~r l-~ ~1.Petersbur~. fiu~.ue ~ 7~s -i , }~`L . k - ; - - ~i~- : i . - • ~ ~ ~ CERTI~ED CO~MUST ~1RRY THE EM'OSSEO SEAL OF THE REGISTRAR OF VITAL STATISTICS ~ , ~ ~ . - ; , ~ .,~;o ti ''°~.lrer~~~ ~certify that this is a true and coTrect copy of a certificate ~ file il~ the office of the Local Registrar of Vital Statistics of the ~ Pinel~las County Health Department, St. Petersburg, 81~r _ 3 - _ _ ~ ~o~ ~'~9 ~~E ~1~1 ~ ~ April 15, 1475 ' ~ ' , Deputy Loca] Registrar ~ , : : - . - • r ~ ~ _ _ . s_~ . _ _ • ~ _