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/,.reoy unlty;~pp •to be • trw and correct copy or the ~~.
degist~ar' fib in the St. facie County Health Ikpan
megf:' ~ Pibtt~;~1QS'
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:-_ ~'~~c ~~ unless raised seal of the St. facie
c;.~ Cptxtty, ~pepirtment ii affixed.)
Y ~ '~ -` He•Ith Officer 6 Loaf Repiatra~
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1980 OEC 10 ~!1 ~ 39
FItEO AEENC F~CONW U
5 ROGER POIT~QSa~
CLERK CIRC8II L^t~t i~
aaoi344 PAGE1 ~~
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