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POLK COUNTY HEALTH DEPARTMENT ~38Q S9 /
William f. Hill, Jr., M.D. ~ •
Otrector •
GERTII: ICATF OF [~i-ATH
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t1E-ra°Cy certity the above to he a true and correct copy of the Local Registrar's record
• file in the office of the DIVISION OF VITAL STATISTICS, at the POLK COUNTY HEALTH
~IA.RIMEN' at WINTER HAVEN, FLORIDA.
• ' i
County Heait~0 icer and-.Local Registrar
• + ~ i1fer' - Deputy Registrar
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. = r?N I tiG : t,0 i JAL I D UNLESS RAISED SEAL OF, ;rtiE,. R?Y ! S i0N GF V 1 TAL STATISTICS , POLK COUNTY
I'Ei-LTH DEPARTMENT, IS AFf•IXED.
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~ CLERK ClRCU'.T COURT
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