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I HEREBY- Tf12 ABODE TO BL A TRUE ANb CORRECT COPY OF THE LOCAL REGISTRAR'S
RECORD~O~~~,Tiie ~ILISBOROIIGR CWhTY HEALTH DEPARZMENT - AT TA1rlPA, FI,ORZDA.
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~::~;•t" }i7,1,;;~:---,~ - Helen A. Moore, M.D., M.P.H., Acting Di-ector, `
• ~ ~j~-)~j~'' ~d County Y.ealth Officer & Local Registrar y
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" • QF TH&. $I3~.52>rc~t ~ OUNIY \/`->'-~i~.ta.a~ ~ '
REAI.'i'~~~l~ AFlIXED) ThereRa M. Luppens, Chfe Deputy Resiatrar
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