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EE..~ 1. ~9~mund 3penoer • Bwrn ; 1 Male ,July 10, 19'jq
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Martin Men?o_rial Hospital 'paw
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fb{Mff1EfEDf?ICE. Nex York U.3.A. Ma~e~' Ursula Loxrie
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it. Henry Bllln Josephine Baxley Foote
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T~.-Mrs. Ursula Bwrn ;:5407 S. Ind. River Dr., Ft. Pierce,, Florida 33450
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f NAME Or 1 IfMSfUAN N OTNTtt iNAN CHifNEE Rrp «r.i../ j MONpMCEODt~ /x... Ii.. r.J nowaRr~njo//pf$Ap M.rl
NA,1E AND AOOitEB O/ Cttf
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Vincent P. Miraglia, K.D. 618 T. Ogean Blvd. Stuart, Florida
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I hereby certify this to be a true and correct-
; _ copy of the Local Registrar's record on file in }
~ the Martin County Health Department in Stuart, ,
rs~~: ' " Florida.
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• (Warning: Not vai~d unlass raised seal of tha
_ - - affixed. )
; K'~~`,~ N.artin County "r',ea~t:z department is
~ ~ at ~ vcCallister ~
Archie` , N,.D. 1
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~ ' ' County Iieay~h Officer & Loca]t Registrar y
E ~ • L~huty cal Ragisi:rar
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