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DATE 1 wpwrw, w•. a.¦ 1 iU?.EfAI NAME-?vwMt •tp wppt(SS ~ fnur oe ¦ r o xo . a+• of yon.., fr•n, a¦ 1
- 2., June 21 1978 neFairchild Funeral Homes 2 N F t
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- CERTI F1 ED COPY
I hereby certify the=above to be a true and correct copy of the Local Registrar's
record on file=itl',~ ~r~13r-oward County Health Department at Fort Lauderdale, Florida,
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(Warning-I~oC va~~~'~es3.'raised seal of t e Bro yard Co my alth De t. is affixed.)
6-Z9-78 f ; F . , c z,, ,
~ ~ Y ~ w ' County Health 0 ficer and Local Registrar
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~ Chief putt' ~,ocal Regi trar ~
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g PLEASE RETURN T0:
LONG & FIIIAfIt P.A. f79 f EB 2 !W 10 ~ 24
801 EAST F1~LLANJP.Lf BEAUN BLVD.
HJ~LLA~dO~LE, FLCRiQA 3309 _ ~ ~'TN
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