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HomeMy WebLinkAbout0767 7[vvwi/v v / ~ s~;,i~ ~r t~~,.<«~a C: ;T1:= i~.r~ 1'E Ofr' GEAI'r-i Uc~~atlmc~it of ilc~:th ~nd ltriiab~lilatiYC 5~cvices r y~ srwTS FILE wG - VI~I~t~I. ~Z~A~T15~1~1~., ` L~•'t y~ REGILTRAfi 5 h0 - r'~ l7N PHINT GECt~lED-HAME • . ~ • r.w.~ . ••t~ SFc ~,Dwlf Ji 'u[wth .•c ~r.. . .e... ~ 1 ~~;v:nNENT ~ CLIFFORD WI~SO;~ _ SAt~d~iS _ 2 h~ale ~ SePtemb~r 7~, 197fi (/~~E ~r~l~. w~4~J. ~Y~~.l~ti ~wo.~~., AGE-.~fr .ti'+e~ 1 rl~~ ~^=1~ ~ _~r CA)( Qf ~.f1~N ,~O«rw, D~~, .C(JyNfY Jf (ICASM ..:.ACKINK - - ~ ~ f1~C.~~ ~ I~~~~w0~~ i~~N~14 r0~ . D~~~ Ni.v~f `t;1~ , ~ , 9i ~ , ~ khite . 6L^!s~__ l . ~,ay_ 21,~_, ~,a L C~TY, iOWN. O~ IOCAT~ON OI OfAiH •+s.o~ c•n wns r~f'vS•'.:w~ Oi O~hft Waii(ULON-N.~Mt ~u~ u~.~~. ~~n ~~u~~ ~4•~~~' . f~l.~~t ~Il 6~ ~a0 1 . Stuart ~---Yes i~~rtir,_ a?eclQr_ial_ Naspital _ . ' gi~TF 01 i~o7N . n wo~ ~w ~ 1•,~ ~i UT~lEN Oi Wnwf COi~t~itY-~-NAC•~:0. hFVEi wu:ruEU. :SUiv~vr~3 SYVUlF r.~~. o,r~ r.:+~w ..~rt ~ cp,M•n. ~ ~ ' w~pGwl~. DNORCtO . l?ICr~ ~ - a Rhcde Island,_ ~9 _ U_._ S.. A. _ . ----i~~-i~,arried _ Gloria_Van _~ocker orcau~ S«,wt StC'~rt2Y 1iu/N6ER ' USWI OCCUtAt~jv .o••e a.~.o o~ ~aa ,,o..~ o~u..a .o~~ or i~y.p p~ ~;,S,rqu O1 ~hDUSttY , cu.w - ~_~~ID w ~1W~.w .~1~. [~'lti ~r ~n.~1o 1 - 039-14-0834 ~ Y~_ce Pre~icf~nt_ ~,~----Fram_Cor~cr~tio;t - . . _ - - - - tE1~JEriCE-S~.?fE ~COUNTY ,GT~, TU~. OQ ~OCw7:Gw ~~~,qe c~n w~n ~tktti wr+D tiLµ~tY ~ . ~~Y~C~~t O~ w0~: Florida - I~.o $t. Lucie itu ~~UaY'L ~t•~ h0 1+••. 128 Evere;ac~~s ~C~i~levar f~f~+Et-wµf ~~~s~ _ r,awi .•a~ lr+JIMtR-AM/J[NNAMf n~u ..~w.~ ••u ~ • ~ ~ {~~G~ ~"'s.~'~-l;, 6eor~2 - S~:r:~T~i s ; ,race - ~hF()MAANI-NUMf !MAti:I:V AJ'vic» ~)~4~1 J~ ~.I O. ~+4. C~t~ O~'u~w, 5~.1~. . „a'~irs. Gloria Sa~nis '~'~t -:r 1 1, ~ ,r in awwr ~ , pEAtM W~S GuStD ~Y. ;f~jFa O.~ir 'vnf C~uSf If~ itNf !03 (e~. (O~ AttO !c)j sar.~~~.. o..st~ •+o w•' -i rrtOUf~ (~yU ~ 1~1 ~ 1~~_~~•..-' ~ I~ . ~ iJ ~TOn~fOVlK~ O~ ~ , ' . , . . iUw0.l~Uwf. .1 I~Mt ~ / ' - . . ~ ~ .I. , . ~ ~ . . . ~ ~¦~c~ ~.r~ us. ~o (s1Jti j 1'~ ' i . . ' i _ Irr10•~\f C~lf~ t01, ~ ~O. q~~ ~ COwHpWwC~ O~. 1~~t~wG tw~ V~OI~• ~ , ~t~w0 C~VH ~~1~ _ . " ~ ~ .1_.~"__~_' . ~ tAAt Y OT„:l SK,er~fKwHT CONDIi1pN5: ep+at~w? e.r.~..~„r.w ro oe.~w ~~t ti~i ~IJtlO f0 C~Yl~ 4~qN •.~i ~ w~ i a~TiiPSY ~ if Y c. ~~i.e ~os e~: j~.a w.•o~ c_o~am on.•.....~..o o~ ~ r ~ c~ ,n.i. ~~V ~ i'.,hrGrl ~CUUi4T Su.f,~J', OR (D~TE~7-w.vp~ ~ro1.rw. o.•, n•u .n:::~ 'HpW fNWR~ OCCUi7E~ ~~wt~~ w:y~~'o1 ~MiW~ u. r.u ~ G~ ~~u u, ulr !::w+?.G~f: O! NMt7tfMU+iO 1 ES~wc~Fd i: M . l1vIJiY A/ WQItR : KACE O~ wJU~Y wur. r.~r, antt~, r.c:N•. ,.~,:w::V~, .~~un O~ ~ ~ o ..o.. C.n O~ ro..., 3+•n ~ ~Srt4n Ri O~ w0~ IMrKi MO~..~K ~1~K~n. ~Nf 1 CIRSIiKwT10N- ra.Tw o~r ~lu ~ rowm o•. .~L ..s~ a.~ ....:..1~ u.r~ O~ a:e/c:o ..o~ r~er iw~: OkAfM OCC.:a~e4 .i i.i •w~. c~. ~n~ ~MtS~G~e~: i0 .w«~w o•s ieu j~oo~ ..TU a.,« ~:....r,r~ ~.re. •-w. ~u nv u. .n~..o~o ~ ~ ~ . / c....r .~.u,.~~oa.e c :•e o~a.s~o rw. ?io i~__i'` ~f lr~ /rt i [t,: 1 r~,~ ~ ~ 1te J _ ~u we c.wi~~~ sr.T CEaS~fKwTKN~-w~iOK~I Eriw/wrrER OR CO@ONEA o.+ ~+i a.~,s w nw .w~~ c~ x.r.. ~wi w~~cv..~ ?sww.w~o o~.o ~~...w.~~o•. c. ~w ~co. ..w:o~ Tw ...v~srr..~o.., . w...~w+. ro..s. w~ ,t.• ~ ~ Ge~rw p(C~~~~D p+ n.1 O~sl w0 OV1 W~M C~ul~.i~ S~~rtO ' :7.. M :IG _ _ . CEfi~I~i~-[+~f ~m~ O~ ~~:w4 j S~G?iATl.~t / . OlL~/e W n:~t ,--GA:. St~htD ~+V«rw q~u~ ~T , ~ l/.~a~I.'~! . i'. , ~ / • . . ~ ' i ~ • •_1__. t' - ' - rtw.~w ;~w[`~tESS-CE;fJ+EI ~ ~ .a:~u.-w ~.~-a n~. "''-f n o¦~t.n.. f r_ ~ ~ s~.~: . i..~ ~ :,.m s:z. - : ~ ?t) ~ t ~ i , . . t- ~ i 1 ~ - , - . . :•~n. ~P~ bJi. _.,Tn~~ ~aul,~vA~ ~~E4'itaV.(li:.~LIM'O~Y- , '.GlA~iOr~ onoa,o~.. s~.r, ~:<f 67CYS ~sqC.... ' . . . F ' v~b12~ p 1 ~ ' ~ - V~1~~ ~ 2 D Al l Sai~~s CC_l~tL'i J- -----L2t----~-- l~'.1.nJ~-CCC`aL~:l--C~T.J~_II.G.---~ ! ~ ~j/ OAiE .rp..'w, c~r. rI~~FUNECA~ NOM:-N~MF ANL AOv~~:Si . 1r~11' O~ ~ r O ,+o .:•*r o~ rorw. u~4. t~~ . ~ ? ..z Septerb~~ 16,1978 Aycocic F,~~?ral ~~.E.Cei::ryerciai,~er,s~n ~nac^,t=ir.3~~.~7 ~ tunlc~.~ yiAEG7U~-S NIIU4E / (k:G~Sr.~;-5...+.atueE . _ ~o.:i •aei~.ec ~oc.. .a~;: ~ X=~•`i `f':/~ i. ~ ~ . ~ _ ~:i.L SP~%~~; ~,1Y`, ~GTQ ~ M ~ ' t . • ; I herer.y c~r~~~v tnis tc ~e a t~ue ar.c correc~ ~ . - • F r' , copy os t: e:~GCa~ :teg~strar's recorG o.: ~ile in ~ . . t:ze :~.urt~n Co~::ty Healt: Depar~::.e:~t S~uart, # , Florida. ~ - ~ (.~arr.inc: tio~ valid unless raise~ sea~ ~ ` - ~iarti:. Coanty :~calt:? ~e~ar:...:er„ ia a~F~.:~c:.; ~ . ~ .:rcn~e '~:c~ai~yste~, ~ . • - • ; Co-u: ~y ::c-.:~t:_ G~~~cer & Locai :2e5~.s~~-ar ~ s - ~l / %'•S~ ~ ' ~ . . i § ~ L` ~ - ~ ~ ~ ~ ~ De~~uty Local Re ~:.l Gj F - ~ ~ 5 3 = : ~~:.CO~DE7 - - i r ~ ~ (.,TV • J ~ ~ ~ - ~ . = 430208 ~ '79 i!l A~f 9: 2 2 ~ fi i: c F gn~r JV1 i?. 7~ 1 x - - - ~ ~ = ~ _ - - - - - z_ ...rK 3 i; F ~A ~4 , "'r"~~h iS.r ~ `a. '-x'-~ _ ~ a~ka -t~ ~.F ...,~~-c.. _ •5 .5i ~C~?`n'S'%c ' . . ~ ...,o-~