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T~ To the Cler.k of the Circuit Court of }iILLS~OROUGH ~~~y, I~ I. C. ~EtAUNSTEIN. D.M.D. M.S. •
~ ~ NAUtE OF COUNTY NAME
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# pf~ South Ocean Drive bp~~ a~ New York~ New Yer1c y pn ~ 12th
; ~ ~ A ~DIIESS ~
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i day of_3~rtraty :1441i_, graduated ~t University of Louieville. KY ~r~ 16 Hav 11
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, ~ who, being duly sworn, s~ys, I am the perwn named in the forogoing license and the perwm nuned in the diplom~ •
which I d'uplayed before the Florida State Bo~rd of Dentistry, and am the I~wful pos~or of same. I b~ve, before
~ ~ receiving this licensc, complied with ~ll the requirements to the examinuion required by laM: that no money hu
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: ~ been Qaid for such licerue, except the regular fa paid by all applicsnu, and thu no fraud, misrepraent~tion, or ~
i j ~ mut~ke in ~ny material regard w~s employed by any one, or occurrcd in order that such license should be;g~r~. ~ .a ~
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~ I COUNTY OF KITS~P c ~ < <D
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' $TATE OF WASHINGTON ~ ~ ,
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~ ' Signed and sworn to before me this fifth day of September ~ 1~;
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1 Signature of Off' r t~`~~ „
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