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trr••rEt•r James Adams Rosetta '~Jatsan
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•etarptp. ~ ~Y.Cptlu?IION. 236 DATE jar NAPE Of CE yE TENr OR CN(MATOpr 231 IOCATgN (lYl, far p.Mter•t11 1ti1'•frl
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1~ 5 StG11ATUNE ADOIIESS 2S OAT[ RECD EtY LOCAI 11EG j6 RE WSTIIAp S sIGNATURE
It••.Etaee ,•;ilton i~. caird ~'t. fierce,~'la. 5-16-61 Anna Lee Lenison, o.r.
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Registrar's record on file in the•St. Lucie County Heahh Depart-
m~r?t at Fort Pierce, Florida. FILED ~p pE
(VUamirly: Not valid unless raised seal of the St. llxie S)• COINiET `A'
County Yealth Department ,s )ff~xed.)' ~~CIRpCU~ifT~ st
RECOIiR vEl;If tE0
N- D- MIIIER M
. - County ~ eailh "rr ~ tf~ aCr,7isfrar _ 4 /(7~~~
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