Loading...
HomeMy WebLinkAbout1695 ~ STATE Ui: I~ 1.0}21[)A L)I',P1~R1 I ~)I• 43S~~Z5 htabtu l~ 1; A.;.•v., Gortmrx Health & Rehabilitative Services- 1)IS'fRIC'C }~}.}~VEN' 1).~U}: CUI:Nl•Y i'AR 1 ti1}:\ 1- n}~ 1350 V.\\'. 14th ST. PUIiI.1C' }il_:1L7H . !~llA~dl, l~lOltll)A ?~i25 I H1:F.EHY CEi?T:IY 1't;I„S TL' HE A '!`kUi? i':1PY ''F 'Pe'.F: IA's.=L :'t:G1:;'I'RAK'5 F.P::~1FtI) i`F_:'•E:A'1'H• • • , _ 1j~ ~;r._..~ ~'riA RwS1I NG : - r' 'f ~ J~= L-._~'/,~-~ J 1 g : ' (Not uali$ t~nkess -he raised see: L E'l:~'~' F,r'.:tI t~. g ~ oJ: t11Q~uYr:&u-poi \'ita11 St.atistlcs VITAL R.~J~DS L;il'~ , p is d1<~~Xe(1. _ :•I~A~: r ~ 1. ~.c~F:I~A ' Stat(-of Florida ' • ~ CERTIFICATE O{~ L~FAl"H tartment c,f Health and Reha6i;itit}rc ~:~T~icrs 4TAT£ FiL£ r:o vt'rt~t. sr~z•IS~rlcs"" F L O R I ll A ~6iG'ia~ REGI6TRAR S ~i0 OtCEASEO--NA.+r is t a•i' :a =UA1T .)r'`F r• I:OBERT lili\itl' F~11;S'I' tt~11~ i)ecerab~=r ?0, Ic~77 _ r - - - " - - - - - UiCf .«.•f. ••tcw •rtf .o... I AGE •s• ( •t.• ur.tt. ~ o•. ~ CATE Or l~ytH . ~CC•VNTr ,r ~raTn l.= iCc ~ h~i j,t _ tt5i~ilt f~,li~(3`y I)ad` , CRY 1C`wN OtIOC!5..;.•+ _.,~A.., +t-t •+.•I. rHOS'.rAiORCinERniSi':~.'.~ _ . n t:ural `•t :1i:e_ i~ ~r• -;8[11 5.t ~~cli Place y• _ _ _ _ . SGTt LII.rH .t ~u• _ - •-r'Lrt4L. Cr wnAr ~:u•.SCz ~M..ti.tCi, NErER enARt•F;, •SlIt:IVU:G SlOcit I r rt , .t ~ -.r• ~ ..t c...„,,, ~ ~ wtt>n~w ED• UIVOECtD s•t~ R Qliiu ~tt.S.a1. ~t• *lurried !~t it~wardille :'tll~: SOUAI SECUtttt f.a.w.6t. ! USUAI RC7./ATivN c •t a•~c ..vu :.--•t (~n«c ~.v oz •KiND (ti 6.:SniEcS OR nip JST?' .,c.......:a. z.t.... a• u 299-it)-852 ~,Sr t~:Y.ltraCt.)1- RorLin~ _ - - - - _ _ - ~ t..,.ct /:r+ wm :STREET AN ~•l v6;J RES:OEN:E--SiAiE 'C_:J•rlr ~Cii• :.1vrN W::XA1Kxi . „ta•'• •1c .tt ~ Nt i•lOI 1~".mil ~:fa a A ~ JI ~O ~ :,ia 7801-~.'r' ~y tti' P1:1ce 1)a l' 12t1r~i1 .t1R;:~i ; _ - - iwint? -:.a.,F ..s. ..~m.. - - a•v . i7..E[ a~_fN N?.•E r.,,, _:.t .a• ~ td. Faun[ 'tart' ~•U:1Cl:l,: H ici'ili}' I NECiRMANI--z.w[ ~ AUKING wLutt iS •iatr o, f c -•O' c.+• e. : "rs. Ttc:wc.rdii:c 1'au: it ;,n 7301 •'=Ht11 i'1:1ce `tiami, 1't~~i-'..1.+ 33143 Irt ....y.,w,r u. ?ARt c _,EAT,. WAS U.U~ED N . ~FN!(t Jf(tr i%••t !A:e1' Ita .-rif jOi :b:. •••C _ ~I, - - iter.u« o•+.n ...o a•+~ - - -.....f~~.nc~ - ~ - q .::f 2 VT~S.3i-is .:Hu.. e - i mar= - - ~ - cr Girt alSt o r1, 4s..f.~ \~t , t l~ihC{tom t _ _ r•.t t..li ca:lrt J~f 'J W •f . C.:w,t f ~ , ,t. t,«e ;.e =woes- 4 ~ n...c c.oa u i ' - - - - - - - - - - _ _ _ _ w~i~-.ar T.r rfi rea( ..woL,et co+.- f a,f De. a.,r n:. ~t: r er ttD rr ..zntrt~..•e uw ` oz ct.t.. ~ ?At1 Y OinER SIL. !'IE:, ANi n'. IT:Qf.S I •n i i?..be.' ?Gt?D{Nl. „nC'E Ot iD~iif d, r.'.e~: - .zK;•.•a riJw Itz i._. .s:z0 . r• v• . .ta ..at r.fi I, nir u. INJUR` kT W!}RK •CE UitN JRr • ..e .•.y 9ni. ~ r I, (jr..'. CIN t••rr• r tG..+- _..ee - - # I tH(.,• nt J, ..01 _ ,.e wpb =TC ~1,tL ~ 3 ~ ~'1 I~ - t. t~. .r w.. s. • ..f. w~~~~.~ '1((~ talc ?t •.K! J. 3 _ Ii •a wt:.. i+. - .t• •r+.a ,.UD. .Ir.f it.i:. f L.•f. a..D. t. MI .(1• CFii.iti_. iA:zt.- - x. p.. ` rc+... (..Dto r«. t _ n 1;^ r t_ ~ r t _ -."t :i a t ; ~ +e. ; f 7 M :4 ,t u..u a a:.ne - ~ T iJ ~ , , s 7St ct<t.uo no.. ~ _ 1 1's i i (i~'~ - ! 1 - l ClRiti t;ATF,fi--vEf r-?: '•.U.ar.ER C4 CC.F('r.fz c~ f.. - - •t e• _zJ•w„ rw•. : ot._ i ra ..t ...f z,..•~.~.. . • u. •t.. uw.w c• ••t r-cr M Df./•• t,l Cl:.af:. M. ~.i 1 (...fir . iC M r?~, J, I, C• • rt•, 1h _:.ttE CER?IfHi--'iM~E m., _Nat,,.r r -.et NJ1':IN~ AD['Rf ss ~ ~ r " ' ~ /1 •-f-~. ~ ~ r.~.'. ,~-`•Z {.a (...~~k~- Iii ~ULIAi. CREMAT.Oti E~.ir Ai fMt E C7 t t vecrn ~.1 C 10 1 Aurial . ~..lr Lary ~~F '•tercy Cei: ' 1 1^1 ~ - t:ATE ..F/A, '.t L a'.-' 4!1y.Yl si f f1 ; ,t ~ 7.. _11 .l:.~. T. i )1 j.: )I~i~~ _ : Si''+';1~=t I c'.:?~.1=- 1!'-'~1F~ 1{1>-,`~ )i: I , r ' ~ 1 IWErw:•pitr,i ;i S i r r ,'t AF a1,•:4'v ~ t z.c •a ttolr+ut r_ 1St _'it' 4,. / - _.'~L: _ lti2 ~/Lt~ /+~i l.~ . ~ (t _ _'___!«i, r 4 _ t t r y t 't• # k~ ~•--~~^i.rlD Uy0R0~ R^~~~,3Z U ` 3U5 1692 'v, ~ ~ L~u~T CLi^RK •RLV• 3L'G! t