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ERMANENT ' _HILL LISK R~ _ _ ? . A'k11e ' - Januat~y _27 ~ 1978
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w Jan._30, 1978 Yates Ftitneral llrnr~, (tr~x 777, Fl.. Pierce, t:lnricli 3345
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,Hereby oerllty tha to be a true erld correct copy of Ills Local
Registrar's record on file in the St. Lucie County Heahfi DepeA- ~ Ac13.~
ment at Fort P~erce• Florida. 'i'3v
(1Narning: Not valid unless raised seal of the St. Lutle 19T9 `y l1 30 P~. ~2~ ~2
County Health Department is affixed.)
FILtO AhC k~ GL•KUCJ
S ROGER POITRA5A
N. D. MILIER. M. D.
County HQ Ith Officer b Loci Rpiatrel CLERK CIRCUIT COU
RECQRj~ V`-PtF'~~-
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Dew DstwtY local Reo~at?++r ''nn
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