Loading...
HomeMy WebLinkAbout0049 , h~~,~~~~a CERTIFICATE OF DEA" Uepa~tme~t u[ Ilrallh ~nd Itehabilital..~ Services lTATE No - - v~'r.~ s7•nT~sc~c~ F L O A I D A pf,(:16TRAR S NO DICIASEO-N~W! .~oe~~ .•t~ ~SU U~rf UI plun c.. .r.~, i • ~~t UN PRINT ~ 'r'LUii~:?1C'r: H. U"i'r~I:'1':i~i~, }ema1~ ~ necemher ?0~ 1A77 vt tiMANENT _ _ , e~ACK INK t~CE .•,q. •.ww ~..o~•~ ?G[ •.o~• ~ ~u»:e~ ~ o.. ~ C~1f W ~uM .o..~. o.., fCC~ut~n U/ OI~M _ . .s.~io„ White ~•.~.e.. f.,~..~~ wa a.~ ~.oo.~ Rroward ~ ~ ~ t. 5 f~ ~~ti, ~ ,iU~. ~ ~ ~~~i 1 ln _ - CiTi, tO~wri. O~ ?OCwt~ON O~ Ofi/H - - - - ~ti~e~ i~n ~w~n NOSh1Al O~ O1M(\ NSIITU~~ON'_ ~~~N[ , ..o• o~.~ vur .~.o ~ /~s a~ ~ u~tu. .is o~ «o Lauderdele Lakes Yes ~ Florida Medical Cenrer ~ ' ' ~ u - - - - • - gt~tt Ot pRM • ..o~ ~ ~ . _ Ut~ttr+ Or w~ut C01N+tnr w~AU~EO. N[Yt~ au~tiEO ' - rSU~vrvr+G SrOuSE . c•.~ ...b~~ , t~"'~•' W~OOW D. !C • Mfc r. , ~ ~ I~ew York ~ U.S.A. i~a~e~' Harald Cffent}?er eKt.f~o ~lu ~CVn1• • . . - , q~„~ MlM6ER USUA~ O~CU~AIION .w~ o. .w. oo~.~ e,N~•.~, ••ou o. ~RWp p~ WSWlSS Ot ~HOUS~Rr ~c:,,r.~e w .on~~+c „y. ~.n. a~ao ~ -~~~•°,w».~~„ 0`~5-1~-4`.>77 :;ct~oo~ TeachQr ~ E:3~~cRLion ~!1'O~w(~ M~OM I7 1~ ~1]? .orifl~Ow . _ _ _ . _ ~ . _ ' lESIOlM~[-StAI~ COUNT~ ~11~. fQMM. OR lOCA110N ~~frot <~n „r,ry STtfE/ ANO NUM~l~ Flori~3~ Broaard :,euc:erhill ~.,••"•Y~9 2?F,'` jT:~ A"'~' :err. ~h ~N ~4 t~~ ~1~ ~A1N(f~Ha~ef ~~tl• rwe.l ufr rrOiMf~-h410(N N~ME ~~~1~ .,oa~ us• „ liarris fiecken 'iALta HF~~'r,en INiORM~NI-wM~E wuMwG wOWElS ~s~~u~ o~ ~ r o..o . a•r w~o.... r•n. n?. d1 Harold Offenther 226U :lW 17~' ^learr. ir~~i~3erFii 11 I~'lorida :'tt 3 ~ ~ wql ~ . ..tii.~.- OE~M W~S CwUSED ~Y ~Ertt!! Orp~ On! C~USE ?t~ lMi ~O/ ~o~ ~b). ~r+D ~al~ ur,.u., o.fa •+e a. ~ Ij ~weun c.wT-- - - ' ~ i~b - ~ ti~t ~~t- ~ , . M ~ ~ co ~ mo..s. ~r .ro :t L~i. f • • S~ ~ ~ ..w~ r e..e ~~s~ ~ (~l ~ j! • '1~,~~-~L~S.i_l,~_ 1 1Yr~01~tiC~Y1~i01, NMfO.OA~f~COwffWM f0~ ~fat~MO t~~ YM~Il~ lHMO (~YN l~t~ ~ ~Afi M OiMEf SKiNMKANi ^------ry - - ~ - ~ - - ~ ~ - COrWtt~i co»~ o..f cpw~HUU~w ro a.+« w~ ~O~ u~.qo ~o c.w~ w•a. •.n ..e. -~~uTaS~ q rES +ne •~o~~as ~ c ~ •~L q(~. MO~ 40~\~O ~M Of~I~Yi...~1G t~. \ ~ ~~1lV L ~~l,.I 11.~ _'~f''~. S ' - _ '.Iti - 0 Ol~Iw - . ~••.e,s4 ? Kc+oivi. w~t~ot o'i' o:~t b~-R+ r ~.an~, Moua -r- - ~ MpD~rK~Ot. O~ N?OI1iRM~NtD MOw INIUlr OCCUR~EO ~ ~«eu «.r~p or ~..,un ?ur ~ o~ •.ee .r+• . ]D` ~M !1~ 7~ iw 7tl . INJU~t A1 M~O~R hA~f O~ MAAf ~ow. n~r. srntr, ~.e+p•. ~ IOCAf10N ~~r~eu c~ n «e rn o~ ap.... ~ 11M(~In t~f W w0~ OpK~ MYG.IR ~S~K~~~~ ~ ~ ~ CE~Tk~CA1~0?~- .a.rw o.. , .o...,. o.. .e,s ~ •~.o u~~ a.~ r o~. . ~ro~o ..o• . r.~ nu~w oeeunto .r ...u. o.. ~M~SKIAN~ ~ rD M O~• M~~ S~Mr ~~rH O~~rw .K1~~~ C~•! •r0. ~O w.I . an~.+ t« i0 / . T~~ oen.s o~w. ~ ~ y~~ l ~ ~ ~ ~r L J Ire . - • o• ...w~~~a.~ . , ~ ~ _ ~ - ~L--i-~ 71~~: O~L1 M O +wLbvH~U i~~•~' . CElTUK.?t~pN-MEOKwI Ex~u~+E~ O~ CO~O~+Er o« ~.e ~.s~s a rw ..o~~ or e•r eec •w«c~,..ew o~.o ~..~....~o.. a nn wo. ...o~o. ~...~~~~..~,a», a».w~+. ~ r» . .o~. " oum ocew.a w.~e e.r~ ...o ou~ ro~~n c•vun~ s+.no )l~ ~ - M A • ! ~ - w CER1WEl -NAME ~e'r a~ ru..n ~ ' S~GNwTUf j ; o~~.~~~ o~ + ?D~if S~W+ED ro~•n•, t~. ~~~`f -r--< _~C. _ "l~c~_ ~.C- l~, _i,~~~~~r:,- - ~ 1--- _ _ MA1l SS-C/fpl~Ef , +~a~~ o~ ~ i o ..o c o~+ si.n . r.. 7H ~ - 1 . ~ . , ~ ' ~~i , . ! r ~ ' ' • ' . ! - , . ) il - /U~IA\. CtEMAi1~N, REIMOVAI CEw~Ett~r Or CREwutOtr-wMF 1pCwl~pt~ c.~. c. ~o... i..u i . ~ VN~n ~ ~ ,y Recaoval ,~~Sharon Garden~ Cemetery V~lhalla, tieW York p~tf ,..o~•.. n.. (~U?aF~u MOaE ~:~s+[ ar~0 wDOR[Sf snn. n. s ..o c.•. o. ~o... s..r~ - - - - ,NUecem er 21,1~77 iversid 1 m C ei 2230 oli waod BtucL Hollywoad. Floride J S. =r612 ~u?+N~t CtOV S Nar~; tEG ? S, t~u~f o.q a~tn•eu u na~:u.• R~v. ~ne , ~ w,,~ ~i /977 ` ~ _ ~ . ~ CERl'f FI EI) C~PY 1~?• i hereliy certify the ahove to be a'true and ~orrecC copy vl Clte l.~~cal Re~;istr~r's ~ record on file in the Broward County {lealth Department at Fort Lauderdale, Piorida. ~ rn (Warning-Not valid unless raised seal of tl e Brc, ~ard Cc~ nt~• 1 alth De t. is affixed.~ • ~ 12-23-77 . = County }iealth 0 ficer and Loca1 Registrar Li;OXD~L~ 1~a iN; ~.+~LZ~j ~.Q OF w ; . + • . : -.,~a • 4~ ~ Ct~ief ~uty Local )teRi trar ~ . . , . . . _ _ - - . . - - . - , fM.EO ~N10 f1~COR~fG aT, lUC1E COuMtr FLA. ROCER POITR4S CCE~K CtRCUIT f v'=°~F~~p - APP I2 10 si ~N'~g 6~JOK~S PA(~ ~ ~ ~ .~~a'x-.sr~_ ~ .x.~ Y_ - ` _ _ _ _ - - ~ . ~ T.. . . x~'~>,