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¦t"~""1 (Richard Joseph w Sullivan~lr. ,Male t December 1, 1976
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tt. 601 North 6th . Street! Fort fierce Florida 3450
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,tf Burial t..lli.llcrest Mem. Gdns. ,t. Fort Pierce, __Florida _
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12-n4-76 _ „t port Pierce Funer ~ l home , 106 So .4th . ,Fort Pierce, Fla .
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1 Hereby oatilty tfifs ro a trw and oDrttief Dopy of ttte Local
Registrar': record on file in the St. ltxie County Health DapaA-
ment et Fort Pierce, Florida.
(Warning: Not valid un~ess raised seal of the St. Lode
County Yeafth Department is affixed.) -
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' N. D. MIILER, M. D.
County Health Officer b Local Rpbtrat '
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O~toa Deoury local Reoi~trwr t. r '
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