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HomeMy WebLinkAbout0671 :39428'7 / ~ , CERTIFICATE OF DEA7H Ib~.N.e.1 .1 Ik.1~i~ •.J R.6.MIwN.. i...4« nwTt I~~a No. . ~w r~^~ FLORIDA ~~o~s~w~s~ wo 190 1~11. W IMMt IN N~~IIA?NNt INt OfCt~O-N nM ~rw~ t W W W~1N ~ r~..~~, ~ W ~w~M~ 1M ,n,wan.~ , . ~ ~ March 29 1977 yC~ ~~1. wNM. ~NKNI AO!-~~p w!~~~ ~ M~ ~ Y!M~ ~ N~ OAt~ O~ WM Nr. COIM~~ O~ Of~M ~w. ~wcr~. w.~•~ ~~~u +w- ~an •wn - „w nu~ ~ 6602 • • White N 99 w a •Ckt~.~2~5 y~18.~99 rwM c~. ~.~n M O~ O~NH ti1V~lOM-Nw ~r w a~r~. Mw ?~m w w.N~ ~ • • ~c+~ nf e~ w ~ Fort Pierce Yes 614 Gardeni.a, Avenue ~ f~ E MM ~r w~ r~~~.. ~w Mnu11 COIR~it~ huinl0. MfrE~ rWMO. ~II~~MA ~r .w. M~ .~~r •rw~ ~ew~w ~ W~DOMitO.ONOKlO ~ 1rK~ ~ , •...~M.«.~~ ~ New York • U,S.A.` Maxr~d 1~~ Wiiliam_.T._N~llflaxdner - ~Y Mf~~Y• w M~~ - ~OMM~ NNC~MM r ~1MN IM M~M~ ~OM N~~N ~OM M RW M M/~MSS O~ ~4111p~ eaw~n r ~.a.r~a.. Kw G „b,. n O99 _ 12 ~ Q1~,4 YY]~P ~~~Ome t ' ~MNMw+. MWtNt~-lt~M COYM~ Gtt, IOwN. p\OCnI~OM rrM tw. ~rn S,~lti ~I~$-~iii~- ~ , ~ M~frr rH e~ rs FloYid ~w 614 G~rdenia v . A1K\-N1M1 ~MM ~MU I~M MOIM~-WOfMNWf ~M~ w~Ml ~iM ~ ALEXANDE C VICLT.O u u.ow~+~r- ,u~.~o .oo.E u ~..wa e.... . c~. w •f..... ~ n.A~leline MaYion +n 614 G~rdeni v. 4~~0"~ I~t~ l 0lAM M~! GW310 ~lMt~ OM~ O~+[ C~YSt Ii~ l~+t /d b/. Al ~?~D M~ w~n~ wN~ .r w.~w , , ~ i' hl t~ ~ .o- - - /l • _ / ~w.ti~~~.~ ~~u ~ ~ M /I /_~i[ 1~C~ - /~'L--~ V ~.tiy.~~~ _ I_Z ~~_~r_ ...~n.q a~~~~ w. ~wrt ~un~~ n~ ~nN~ • ~+w~ t~~M ~Nt W ?ut • Ot~l~ fD~w2wA COMOeD?r. cs~+wn crwwr a w.. ~w +a w~ •e uw~ ~w+. ~.u. ~ultoHr • rr S.~.~ .~.•~.s~ ~e.. N ~01 YN~~~ r M~~~~~w..~~ (~wf M ~~~r~ • or 10l~ YrO~t ~MN~ M•. nN~ NpW INAMf OCCVNtO ~t+n~ wwM e~ rww w~ r•N ~ e~ ~~a t w. ;y~ f~ r.. w • ~NIU~t • wOt[ .o.~. ..r. ~w~. nc~ow. IOC~nOM ~ a+n~ M ~ ~ • re . tw~ m ~r. rq r ~ ~u~~n.~~a.w~ wnc~ww.nc ~wc~.~ i fA M ~ „1 CI~I~K4~Id~- ~OMA1 M~ hM O~r Mt MN ul1 Ys 1~~~M NM M ~ M/M r0~ A~ fM M~/r OCCWM~ N M N~f~. M wi/ ?I/tNC/lMr tO I~Or~ M~ ~1~~ ~M~ NM M~r1 ~rr~~ ~M. ~N. ~ ~N am.~n wr / 77~j la ~ , ~11 tN . 14 7_~jr~ e~ ...:sw'en.~.q 1ti N~af~~ ~~o. . • ro r~ or•sr v+~ !l Cttliiulroi~- i~~~aoir~! ..rs ' .oM o. ~......~o. a ti .rie~ r r.n.w~w.. , .~o~.~ • M: ~ M • a.• .aM L v N... acw~» o+ NA r~ ~ 1~ Ir t~~Y~Y q • ~ titZi i i- -i+M~iwri M ~ww . r ~~L ~-L_ ~ 6~i 3~++(0 . ;S • fw A;~ _ a riRMO M7q[ff-tf~ Af1 s~r~ ~•.o .w w~ w~ 6 North Sev nth r ~o t ~I ~UMAI. C~lrN11pN. ~YO~AI !M!1lf/ p C~lMAIO~~-N~M t(KA1K1N t.w e~ w+w • Y~w ~ 1 WGn ~ 6;iEntomb~ Mt wu~ MH µl~re wt~tao soleum~ Fo»~~c.~ P~ e ryc~~r-~l.z.--- ~ _ _ril 1 1 n. rt i r •un 1 ) ~t. i rc la. t. 3• lj f V p.- t ~tWilu~_yG?uhl~ • o~p nun~s n iocu acnn~~ S ~•..l~to a ~wi~raI`Ch 30 1977 € s{ @ - ~ - ~ . ~ ~ ~ ~ ~ t heroby oertity thts to be s true and oorrect copy ot tf~s Loce? F;V ~ ~ Repistrsrs record o~ file in the St. lucis Counry Hes4h Depart• - • , ~ mK?t ~t Fo~t P~erce, Fiw7da. - , ~ _ ~ (1A/aming: Not valid unless raiscd seal of the St. luci~ County Health Dspar~ment is affixed.) . . N. D. MILIER, M. 0. ~ ~ Gounty ealth Offiter d~ lotal Reg~strer ~ ~1 ~ • ~ ~ / ~~~n'I . ~ ~fl~ ~p111y ~OC~~ QEO~s~•~t ~ ~ ` , ' E' R P0~ R~6 ~ ~ ~ r~ ~r~ C:?GUIt CCF .T _ • . ~~~cr1E0 ' a ~ ' ~ f-- 3` r'~ : s ~ ~ n ~t4z 8~ i ~ ~ ~ ~ , ~ ~~~Kzsz PA~E ss~ ~ ~ ~