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HomeMy WebLinkAbout0966 1 t 4414.156 ~ I I)rpartll•tnl d 11. r11{. ar..( I~•(,•i.•u1..ln. v,r- _ ~ -1 LTATC FILE NO.___~_r. r_._ _ INt 14u\ut Itl. tl 111 i C reJ .a./!~"1 • J. /9~Nt tN aaa.vrrm•:n..,nra 1«ti 1 u fi'a REGIE:TRAR'S NO. ?t1MArl/lhi INK 0[Cfw3f0--NwME ...c:.•r .att ,EA ;OATt W Of wiN •.owrw, s••, tta11 Iii n•.~IiJE IW _ .1fitJlltWS i j~f3Lr: _l ('t~:~ is ; 't "y^.::.i~ G~ ~1 i~c~ywtl~ Z 9 1 FACE t•w•tt• w14rJ. a••I a..•r ~rO.a•. ~ A.,t •~y _ _ _ . _ _ _ _ , . _ 1.11E CN ptrin . rowrn, 0.., ;COUNTY y. EIEAIN PC. 1tl1t,111 ~/•IM4•- ~.1•\•.. ,l,,.t ,ti?.•t rn• ~ a :~r::.~e :c, _ ? Z ~a-1 f;~-:r. ::actin y+ 2`/~` C{it• TOWN. O! IOCAiiiw Q? UEATH .••,tr ..•n-,r ~ .•i: j~.7A: U:htli •r..flillllfiN-^N6Ml ••r rV, .w tNwr.•41.t /tYll .w0 nWla1 r n iLa1:`t 7, -7• r•~-i+-: ,''.t;!''O^:n? :.OS~lta2.l -7 A CVVNrrY •.:•-.ia,:._.:a•wyatb.~ T;SuRtiNV+GSrOUSf.•.wl.onEr.wa•.wwl :MIE Cr! P+t1N . r nOt v.t a • ..•r/.Cti1•aN W 1 atnwrr• r' , w,uJ'r''`. : i 0 i•rt?• r _ , t . . nvcr•,•. ~ ! ilil $con ~ilR t - ~ _ .11. - S:~n~ ii c~T~i P.S „ 1.~ n• Sl7C1At SECUatir rrJWC~ -----'----~u1-t~Ai OCCur~,l~:,i ~•.o u..;»....- _ ,ruts Q~ i1~YvD 0E WSWESS 0E 1hDUSTRY 1 '~;.«,U+r i 17 + '77. i.OUset~~ lJYin_home rlwn , . 111 ` "'•awrCitr,w:~ SLiEt IWD HUMiE4 ".ta'.^ S ti31OE?+CE--SIw1E :COVNII 4.Y, •Oww.. as IOC/•'. G'. , .tae... sea w •ro 1 lt., ;'iAT'.E~!3 i:~_2':r,-. •1•. r'..... .Ci X11. :~O ~i.. tiettl~'.:i ~91t1i]f},tZ'i~? r IA1nE!-NAME •?Itr r,.trr ••yt •tv:r,ak-MA.i•FN NAME r,tyt ~M•/ utr Lori IiYl k3.oort =c, - Irene ?dassey IINEQIiMANI.-NAAaF I~~wtt+? A ,11.r1• d..10 J, air. Qa Wvw, fr.tt. ly1 ::r. n:...s~li _ ~ vlfss isl~n~, Jensen heach,Fl~rid: /ARt 1. pfwtn WAS CwuSEO RY twtr G~i7 r.r:i t:+US[ rN IwE IG. teL Ay wno (t)', '.fn+u+ t7wsn .ws Werr .c+ i me ro LA: ~ tt . S `~S ~ •rrlcuq tauH .oy ~ a1•n.c cwt t.w.n• ~ w. w at • :o«tlcw.,c1 t7+ _ ,uwo t•vat utt i ~r-rAU7CN1Y-T V YES ~trt ..ro,..Gi t~+ 1 /AR/ R. OinfR SK•NYII•ANi CptEp/iphi- rw:ropwt CO••la••YnM~ b 4, •r• /Lt wo• uugo ,u Vrtt 4wrw w •u1 .,.r ?1 •a~,M Nor ~ 4+trrrY ,M gltr.lw.wO laVS1 1 t Or OratM _ i7t. t0 (Iw -::r;=,i -j i;~~~u:7"~ r:u^•-Oi--Tbwi! ~ r•/tr!r ~~wi... w: :~:a: avR Mp.v iN.ulir OCCUEI[D ~L.rlr r.ar w rw.v.• 1« ?u• Lw ?.n n, m. Il l -.w<.:13c: of woitiuot:.io t«.,,? _ _ _ x+ _ A+ : _ 11~luCY AT WQit-~~ •.ACf Cr r`ir11t~ .I uu~r. ~~aio~•~-,p[A:,VN -_~avm or . r e wo . tm O. to.w, n•h 1 I trlC.r••tt 01 w0• ~Wwtt MOG ,TIC .VIC••r, +t ; 7 ' G. GTiftCAiiQN- rp«•+ r.'•wr. 4a• •err - s••. r.r.wt1 •1••t Ow `1 :r<o/~ Tait r1s MIt DI Aty OCCUttEO ar r+/ MCI. O•. t a•NSlK1An: ,r~ iCr ~ ~ , "~..:w••w ~ . • ~ n•a a..o• ••'ta ous. ,rOyl ~ O•tt, ar9, r0 s.r p,r 1i. .nlrole 7r1 S l `7 l ~ . •~V f t. , , , . L. c~ ! I ~T r o. rno•-letc.. . 1 11• Dltr•tr: rt.t. _ _ ...?_r __-_______r__ ~'-,1-'. / ~ 7rt ~ rltl ~ r0 1111 CAVf1111 :r•~t t "'-7111 _~_~_a«____ CfRTt/~UTrON--MED~wI [7iAaMNE4 C+ G:=O`,i~ c-'+1 t••.t lu r.y Jww o• w•1+ ~ •'w W:Iw t •t •.Owtru uo n•. Itarw,.tgw M'••I 4'V• aw0/O. rN .Mrtth,••-.ter- Iw r. dr w•pr, w0••tw Oa• •raa r•dyl r-•-+ , r C/atr tICCWf0 Ow 11.1 Matt ar. ,vl 10 ,w1 V v11•tr t•ailo ~ / / U ~ ~ / J O M r 1 7.• _ _ _ _._y.-___ _ - _ _ _ CfR1rt1ER-NAME tnrl O. rrr•r ~ Sr(i+.wl u4t f • ~ y~~,~ LK owNl ii 6A~E EO ~•M•TM, Oar, r -h-----r 7,tS wagWG ADDRESS-Cf11v/[t - ro J ~ c.n o.~totiN uarl pr lit ~i~ ~ t-:. :~iCf: .1r1'_i:?"r~ lari~'~a SURIA?, CR(MAigN, R[MOYAI ICEAU iERY Or Cu MA7Cir~'-NAr•E IEiCwitON Ur• O. t0+••• Sett r YKrr r removal pit. A'_loLez Ce^:e.ery ,ii•t ~`illou@z T~rp.,Brown Co., Nis. _ ~--ww•t M:u AJ-?ESS •y1t'o1 wG _ C,it ,O.~fO.r. Pall. L. • / r DAtE •a•OwM- Rar• r1 •a r tUNkti Ai 1{''74•.x- Iw ~:ay 1 0 1 977 ~~.t.f`i . `'^.,-1,-.,-. ~•S '_VC'.. N'O:'t ;,s1tJ('1t?T'~~?1 f'. ~'1 0 1______ ~_1-..,~__... A. i 41::x- -A:, c c`.- ~ i /y i . OA• ~i,vao .r :4Cat l G trrA• S. R6i: iUNltp ~'yCiC1R~5h:i~[aiu~ r"-'--' l .j ~ _r- I EI~r. ]070 ty l J ~.~X..:.i~i=' 1~. ` ' I:._ • I :~]ereby certii}? tr]is to be a true and correct copy of the Local Registrar's record on file in _ ! the N.artin County Health Department in Stuart, Florida. .•?r• ~ (Warning: dot vai:~d u~~less raised seal of the • Martin County i~eaitr] Department is affixed.) ' . i Arc'rti~ E~icCal~ister, M.D. • County Healta Officer 6 Local Registrar ~ 44141511 ~ ' t ~ Fl.ECt • Date eputy Lgcal Registrar I Si.LtJCIE CGu'i~Y.Fl7,. ROGER PUITRAS ARV ~~F Ij i. f:' ~'JL111~~V frV< er ,