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HomeMy WebLinkAbout0005 ,->r tr~Rwi~~Mlk ~L1RJW1"~+~~~/A+ ',/~~+~'•*R- "aY.a'!.f'S<..s ~A-. --.r~ ~ ...e':~. . . -.,.r~.~,w+ rw ~ • rr+~+rz .:.~s..?: • . . . . . . , t ; .._r.~ _ . - . . _ ._C~~ . ~ ' ~ ~ _ • ~ . • r= . 1 ~ . - ' - _ - S ' OCEA'~~Cpv1~T , . ~ _ / . : ~E~K C1~6 , ARO VC~.:ctED ~~t~ ~ ~ {~3 ~ oct ti . ~ c t v.s. ~0 11/1~1 ~ co~es~ ~~~~~~cT NEw YORK STATE s~~~a r~•~ ~u..~t~ ; q OEPARTI.!Ef~T OF NCt.~TH : c u~sus su~• 8tlREAU OF ViTAL ttE ~Oi'.aS ~ . aY~s~o.. .a• C~RTIFICATC OF Q':ATH ~ I._ L~_ ~ ~P~ ALL ENTRIE3 OR PRINT IiV PkF.~.iANENT ELI:CK INK. 1. NAM[: PI !T woo~s LAiT t. sta o~*c o~ n~~*N ' Y~L~ /IYAI~ Y:?M1M C~f ~i 'g• ~~w ~ •tu •t.[q ~.N~K• s~ey j;• 3(~rJ!{~.~e ~ ? ! r K~~ ~ -i-- . : JUI,Y~ ~ h975 c.~i0 - , ~~cc: IwM~tt. rac~o. s. ~sc 11 V1~0~11 ~~A. 1? 4M0[J1 1 OA. {A. •~?~11AM O/ U.S. AaM[O /011C~lT •o. res_ s~ac,~r ~ wu. » ? •YL\~C~N IM~INI• pt.l ~ YOyTMat ~AT• MOYAi i Y1M. 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