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HEALTH DE-PARTMENT
- 614 EAST GRACE STREET
EN(ilEW000 ANNEX PUNTA GOROA. F~ORIOA 33950
PHONE: (8131474.3249 PHONE: (8131 639 - 1181
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I beretyy certify the above to be a true and correct copy of the Local
Registrar's records oln file in the Q~arlotte county Health Departitnent
at Pinta Gorda, Florida.
~ (1Piarniug; Nbt_valid unless raised seal of the (fiarlotte County health
4 D~rtrnent is affixed.) '
180 MAR 3 I JIM ~ G 9
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