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Vs. ~at2 i _ a - ryas a rn n aoua aaogra•a i
Aw• ~/re ~ :~~r. June 21 1977
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heroby Oertify this t0 be a true end correct coPY tit itte Locat JT
Reglshar's record on file :n the St, lads County Health Delaart- ~ ~ , ~ -
mattt at Fort Pierce, Florida, e ~ ' ;
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(1Afarning: Not Valid unless raised seal of the St. Ludo -
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County Health Department is affixed.) ' ~ <<-, ~ - ,
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County alth Officer b txel Registrar
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a'"~ Depwy local Reo~et.hr d~~H :9~9 S€~ 24 P~' 2: 29 .
- FILED AtiO RECOktIEa t
ST.~Wp~CIE C~;NiY.FIA.
i aF.lO< Ci~T ~ S '
RECD20 ~R~'ED
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