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e_ April 19,1980
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Iy f» St. Lucie Ik Fort Pierce lli 5401 So.Irtdian 'v
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f7a 1>.. 5401 S. Indian River Dr. >:brt Pierce Fl. 33450
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1 Ifa Rara_ va_1-Burial_ 1.. Tappan Cemetery E«_Tappan, New York
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t. 1» Yates Fluleral Hare Inc. Bar 777 Ft. Pierce Fl. 33450
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I 11 Bernard D. Ross I4D, 887 E. Pr'lmd Vista Blvd. Part St. Lucie Fl 334
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C Syr-••~ 71a ~ -1~G~ ~ • / ~t~°l.~,~'~ - 1~ Apri 1 23, 1980
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St.IUCIF CGGNTY i(A-
• ROGER POfJRA~
~»roby oertlfy thk to be a true end oxrbet dopy of tFte Locat JERK CIRCUit Cf~l.~ Q
!9ictrer's record on file in the St. facie County Health DepaA- - F•a'ttttt ~!=t!•, G]. 7
ant at Fort Pierce, fbrida. - • - ~ i
(YVeraing: Not valid unless raised seal of the St. facie - ~~351
County Yealth Department !c affixed.) i
~ N. D MlIIER, M. O.
~ County asth Off;caf Loaf Registrar
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