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1... I• I«. Port St. Iucie Iw 2555 SE Cowin Ad.
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William F. Malzane, MD 412 Balboa Ave., Stuart Florida 33494
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NfS fr.• 117, INlllfr At 1MOee IS.,•./. rr MACE Of /NMr-A~ tw~i. err. ••wr, t•cti.q. •MV twrld.p, lOCA/gN SleEfi a e T D. M. Ulr a IOwN frAlE
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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.
Florida.
(Warning: Not valid unless raised seal of the
. ~ Martin County Health Department is affixed.)
~ Archie McCallisterT M.D.
n - County Health Officer & Local Registrar
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bate eputy Loca Reg stray
~ BOOK~~ PdGE~~
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