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HomeMy WebLinkAbout0688 . _~.•~_u. .••._r I~C11~ ~V~\~?JINII: / / : i ` DEPARThtENT OF NEALTH 'r2~~~ v 1 ' 1 1 ~ •y ~ + ~j~~~l~~V~~~ ~.l~ ~~t~~T ~ a~7 . !~-i~ ~ ~ , ~ ! ~ h~V! f~4S( R'IOC1C lA~f _ _ _ i__. ___-T :4 , ?t~ ~ i.• ~•r. '.t.1: +~N'__, "s•:C~~Q~±/w~CT ~ : . i ~ ~e'- l, iWef ftvxlf w. , , :a:_ .[~a , } `-y ~ F•10/I,2It02 ~~P~~/t I,CLU P_t` ~ ' ~C ~ , i - ` . ~ - , ~ -j--. ~ .__5: ~o °C ! ~~wa~f e~:tE C 1aa• .tLV~fR~~f~9 ~ilr•~::'qtUw? aD'QD,vlh~s~r~ ~ r~.!!a~a., . . •;u~ . . ' ; . •V~A':~V'~' •Y ~ . . . _ _ 1 ' ~ i ~ , : ~ • . . . . I ` . ~ ~ ~.:ryi~~tiEl.• , ` `y..y.r~: ~ l~~y+ N~i1,4'. ~ 4•~t . V..• ~ : l~Y i •1~. • , . '..t'. , I '~4 '-"lu-f.~___~__l---G''° i ' i_ 12 ~_!6 ; /o ~ ~ _ . - - . _ i ~ ~Z~'a~.~ =.~v(.~ a~v:_..r. .~_~.-.it:.;~w•.~~~=E::r~t ~ ~~~..~~.+i •a. . , ~ .LJ Lca',• ~ x:~i~~ i ~e . o . a. ~ ; , ~ ~ ~ , . . . ~ . , . . , lL:.e ` ' ` 'W; - ,~.''z• `['iu~~[L~iD ~ %~~lLC1~ ~v~~.I2L •k: r.. _ ~ • / / iQ~a..~i£O•.a~w.-'_ _ . - -.n:iuna:StaTU~C~ _..r~t~ ~ . . • . ' ;(:4\"~1~~i\~:'~.• . l.'_ , . . . ~ • 1 ~~E~Ca uwaw~EC e:GCnC? _ t ~ f ~ ~S~ ' ~ ~ ~ll~ r ! t ' ~ M (-7 ~ ~G2 ~•c~-: • r'F # ~ • • . 1 ~ V1RA~ED ~3 dY~M'-t D ( _ ' ' _ " ~ ? a ~ ~iUU:~a_~.~r.:o~•.:j ~ •-•1w:vDOC4vS"~[SSQA +S• :cYUt•.F[uNitv~-~~!•:n~~+,r•~N.a~.~r~... , . . . ! . .trL\ ~c HELRIV.~ ' . :*H~ bti4dfM ~ •:l• •t ` _ - 1~ f~ 1 !tf'.•{•~ ai.• .1 • . . . ( . --i ~ ~ ~Onll~! (JL(i~'~ /NC i j~~a?7`'~ ~ ~ . . . . . ; s , , . ~ U, un~ tnlx/Jn. ~ ~ ~ ~ 13.~ST~'E ~1:"~%'~•~!• t•..:LU;A!f!Y C !t.It.li( Rf~D",Cr:-: J-- : " . ~ - - , i ~ ~ S{l~ ~ . ~ ~ . . . . . . . U 1 ~ITYOF ! f f ~ ~ I tUWNOR ~ ;sx~ PESILERCf i u`;i y ~ ~ Zt~ + ~ Qu~~~ ; , • •E~~ DfCfCENT 1S0' _ '~Li v,tuG_ o~ - - - - - , ' r • r r : . `V; ~`.t.•P:ET~`~7.~'..v7:a' i t L : ic~ SellEat .S#. ~ - - ; •L• ~.1..' 4:i'..lt L~:t _ ; "-_-~',-1..:.... . ' _ ' _ ~ ^F ~ ~ -.y t ~ • ~~~.,~a /•IKII! G/t,C,~ .(,n. ~ ;;a:' " St11tt,.'2 ?QtI~GL~7•^,^-.~1G't Z ~ ttw\avE.F~•.:~...~itiy• ~ ~,~UO/~n....~~I•: ~ :S;.q~_tc"c[:•~•~.-,~_:_________'___'.~ ~ i ! ' ` i ~a.Ct..PJi A'CLI,Ce~t ~ !S~ .SClteart .5~., Ctt~ Pr..iQ, !-i?~=Y_) ; - - - - - - fisw tl.~~wl Cw^1w•w7•a kl•::.v~u;~tir.~ C~• tl!~JPIACCf:: GVWIA\.LNt~l::.i:Y~ .~RLV ~..:i •y . i: , , ;-----t-,-- i': • ;i ; lo' ~ ~ ? ; j ~6 ~ 7G flo.Gt ~iro.~e Ce~f~ ~ Lc~~; :--r ezn.:.~, r?. _ . , ~ 1laNAVE/~.\D/~~~-:tG~SCfiUNt.:si. .tl: _ ' . 1.~..~- ,.a:.:'.. . } ' ' r ' ~ !p~ !'h,~.s.F.t~;~c 1~3zhon. rcv~~ca.C flome, Inc,, q~~ ~b.~o~t_ ~2~., _Gf.1v.,A: r~• - ` ~ e ~~I:~.~ANAV(li{: "~•'i~~..~~..' 'a ~ .I'.': : ~ .1 1 . -1, . ./~1,' ~ ~ ' Lj hu1%le.s F. ~c rra' ' ~ ' 1-, o}7S~ _ ~ ~ i " _ ~ ' ~.:..~i`~` ~ ~ - - - - ' - . ~s•:~~:_~,~r~ ~..t~' E . ' _ r / 'f - ~ . _ .rov_ ` _u.. ~ ,a • - : . - • , ~ ~ ~ r 7 ~ r: ~ ~ d~ l ' ' 1 a r- : . _ I; L C • . ~ , . ! TO 8E C01APl.ETEO BY _~R_ " TO Ec COi~?Lct ~t~ f3Y { j CERTIFYtNG PHYSICIAN OVLY 2~ CORONER OR ~ 1[D:CAI F~;::.~: t:t~R Ct.~Y w TU T.~E BES~ rc v ~•.~~rtE O_.f Dt ~.eCU: af Owr ~ w O~ r~~• !-.r ~ nr r.~••,•, r.[ ••:e e•;,. ~ Tr~EttVECAtFA•~DR~::E~r~ryQUEI()7~~L ~ l:~-r..i)'1i'•Al.~~~%~~f~t~.~,~ s~fr~lltVi..~...e....,v,T::,, ~ . C~u5Ei52wtiD V"YTN OA? Yi~q~ S'11~•LLI~J'~I:~_~~4i~'~ ~ / ~~/~'jIJ/lj_! 1'y- t ~W('Sr~SMED , tLl~'=WI/. ~~~rA=-.C~ ~ k3 ~j~~. :.co.. . ~ - . . - - ; ~ j. , . , . . _ • 1i{I ~ i +r~rS.~~.b~~itEr.;;eOte. GCC<a:F7 ~e t~8• ;LE`~A: ~l ~ u r.. t. ~ ~ ~ .~~n . ~ . ,ri V7+Yiv:.^It YE~N V:iY L~~ `k~P~ V~_Yf~~ ~.^.11? ?!~i~ . I f . . f ?:h • . . ~ ~Q~ _ 1..._~_ ' ~ f..._ ' _ ' ~ Uj snpw ; ~ t ro ~ ~/G ' } ~ ~ ~ ~ / ' ~ py ~ . 1 , . , i ~ • _...-a___i. ~ / , ~ ~ F ~ ~__.2 _ ' . . _ ~ . `~AVtO~AfTiY'i•.~'iCY1~r,'siC1AV 'f :~T~•[rI~11AyC111~r[~~fl ~ I.t~s: ~ . , r • ~ . a . . . ~ . ~ 1 ~ 7~~:~vEI~hU.~DJnf>SG~C£a•,s..•n ••r~~y~~~N CJN04FR.VCOICALE)AV:>*.t~.COn~r..-~v~, . :e... ~ _ _ . r.-l' ~1 . . r- y'_/y ~ . . ' ~-.G~--.~i ~C_'-"~-_-.-?`'!~ ~ y a ~~Gj_ - _ - . ~ y' _ : . ?S OEAT~iiry~^.CAr~SfO9Y [NiEApIIYOkEGVSEfENl1N£f. •~.:~tl ~r:'r,C~ ` ~ . ~ ~ ._'l__._' . , - _ . ~ . . . ° ~ PM7 ~4fr[C~wTE U•~SE . ; ~ , . . . ~f ' i , '~lIA~~[i~lE 1 ~ .t~„~C~r~,i-,~•t.qr ..~a~ , ~ !w ' _ - ` //.~'/o-t ~ - t u~~~ ~ DuE Tp CAwS~CO'.'~EC4EMCE Q~ ~ . _ y~, . . ^ _ _ _ / ~ C,.'~SE l~1 ~e~ ~ "~r.i_?;_ i St11tt!IG TNE _ - . _ - - - - - - - - JYpE1~LTI.NC OYETO.ONASACO`'.;~UEYC[f,i - , CA~Sf LAST w , ~ , . ~ ~•OnAT~lf1TH~q'.. !i•~(~.. . ' ~ 4 , ~ t_._"'_ . V CEArwe:y' •.:.rwE:wti~~• ` . ~y .i iµ~ ~ ABtl1( t~ ~y1wt7~(.~SV7 • • , . . . . ~ ~ ~ . J~7/ • i ~ i ~~(}j~ 'w' ` .t /l~i~LV'•1l~G 1~! G/~~L~~ -t- ~i~ ~ Y~•.~~ : ~ ~1~°.9i^_l.V^t(fr~, ._Si~ra•.c~a,. ~'_._~.r _r i~ ~V ~^-M~.c- • ~ 4n Ll[:.cn Lu:*r..-. . .~.a , ~ , . ~ ~ - _ . , ; 4 ~ ~ ~\'.t.e. ~'GAt~:rV T tr. ` •[~M r - ~ - ~ I r-- -----r 1 ' ~H11A i i~L ~ ' ~ ~ i ~ r . i ~ ~ ~ ~ - ' ~t lEIr~.UprArn?G~{9 v•sn~i...s~Nrt•A~ ~.p•~r ~ `~-?t : ~...r~.rJG[~r~fai.~-: --~ri•..~.~....r ) .s•~ r' _ . •ES M~ ~~~C~ONr.Urwttl~d..UG ~ - _ . . ~ 'r 1 i ; ~