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T JOHN B. WATERS , Male , T`W? 19 • 1975
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1«tia 2 75 TT.Yates Filner.~l Ilene P.o. 777 Ft . Pierce Fla. 33450
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tn,. ana of n+. Local 1919 [fie`+, ~ 6 P~; ;2: 33 4S62S5 .
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NpMtra/s record on fik in t1,a St. luck county Haelth DapaA- F(LE~ prL M~ L.:<'•i?i G
etant FoA Pura, Florida. $T.LI:CtE CCLyI'(.FL".
(yYarning: Not vend unless rased seal of tFla SI. ludo CLERK C;FCL T
County HENIIh Departrnant a effitced.) - - . - 9 ~ ? .
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8 ~{~K 320 PdcE 1515
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