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Certified to~e;4~iue' - ct copy of the record on file with the Division of Public Health.
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City of St.- ~ ~ ~ ` -
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Alteratio: ~ ~ thority of Minnesota Statute 144.172, and Regulations of State
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Board of ~
(Signed) - ,this 9th ~y of MaY 19??
g}errar, vital statistics
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JAMES F. LITTMAN, P.A.
Post oP~ sox 1197
Sn,~. ~o+~on~ase •o R 4'73 ~cF1421
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