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• Date No.
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This is to certify that .this. is a~ ttue copy of the record which is on file in the Pennsylvania
Department of ~:H~lth;, jn a~cor~nce with Act 66. P. L. 304, approved by the General
Assembly, June 29.1953: t,'
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(Fee for this. cectificate, l2.00) Leonard Bachman, M.D.
~ Secretary of Healch
Harrisburg, Pennsylvania
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