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HomeMy WebLinkAbout2274 5~L~3~31 '~' . s~:,~~ ~~r ~i~,~~a CERTIFICATE OF G ~1TH ~~l`~ldl lllMtll U~ El~•:t~1~1 :i1N~ ~{CI-.1....1t.tltYt• tif•rVil'PS ?TAT[ i1lE NO - -- - • F L O A I D A ru.~ vrr~~t. ~•rn~ct, nEC.16TNAR S NO 1 YPE OR DR1NT ~OECEw.tD -~+uwt '~~~ ~ r~~l~ rSt». ~ •ro~~ ~•~~ St^ Ib~~t O- Ot~~H ~. ~ • ~•• •••~ K. ,1:~1~. ~ 1~iG1.1`i ~t 1•~•:;:~li~_ ~~ l~~•~_,,•~~t~,•~=i~ ~ :'~; i PfNMANENT BLACK INK - -- - ~ACt ...q ..~o. , ..~a;.v ~.o.... ' ~Gf ..v .~«c~~~, .~.~ - •- - ~....cu ~ :.,. f~~C~lt Or H~tH .. ... ... COU~at. 01 OF~tN 1 .~•~ ~ ^ ~~c sr~t~s. . ~ ~,.w. •~.~~. .o~ ~ o•.- , t.'hi t ~~ ~. tt11 ~ f ~ w.,~t ~ ... i~, '. ~\~i iH, 1~~~ ~~~. -tt ~,t::~t ~1 : 1 ~ L ~ . i ~--~- ~IIY, ~UWN. Of I~AIIQN DI ~[AfN ~~+f.D~ (~n ~r~ry - -------~~-. ~---- ---- - NOShI.~I Of OIhI~ NSIIIV1bN- ~.~M( .• w(i~ w 1.•~~~ •.•.1 ltry~• ...D ~..~~1~ (! ~ ~.r f~~(~~r ~If O~ Mo ~ _ -~ ~,,•~.I-t ;,~1,~ t;~~,t~~-, ,. ~•~~5 ,~ r~ ~t S.N:. it-~~ f~~:t< ~• ~ St~tE O~ f~~fM ~. «u~ ~+ v~. ..••~{C~~r2[-~ C~ v„~t COUNIRr ~w,~tilD wEvl~ MA~~IEO ~SV~~.~vwG S~'OUS! ~•~~e c.~ .. r~- ~...e ~~ coo•.,~. ~ I w~I~O'~'J 0 Orvp~C(C fnc~•• ~ -w~~noa..~ ~ 5C01,~:ltit~ ~~ f~.~.r~. jH ~1:iL'Plt•tl ~~~ ~~I~f~t'I ( ~~1~i1S ' .+u~ eea.ue ~•IC ~~ N~~+ SOC~~I SfC'ifrtr r~uMsE~ •USV~I O(~U~~T1Q-1 •4~.! a~.~00 • ~'rC~~ OOV~ DybM4 rpS~ W ~RINO O~ WS~N~SS ~~ INUUSI~~ • O :~~~~0 ~h •M~~rG ~~~1. f.~.~ ~~ ~f~~~10' Y ~~,"~~•~'•.'.^" .n~eu+a ~iwa ,t 57$-16-2395 ~a f~i~tls~`:: i f t• '~ Ut.''~ Fi~,t' ~• ~~ •o~~+~~ - - - - - - - - - - - RES~DEwCE-S«rt COUN~r Cnr, t0~ Of IOC.-f1pH '~~•o~ ~~^ •~~~~~ S~~Etr ~r+D HUM~I~ ~ ~ ~aF1~T~i~1:~ ~u fit~,~::~r~t ~aU~~ert~i . t , ti.e.... .~, ~. .q ~ ~~lcf fi~~:,~~t, ~~~. 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IOC~TIOH ~ 1~~~n o~ ~. o ..o u.. o~ eo••. v.~~ ~ ~ 1 ~MC~I~ qf O~ w0~ W~K~ M4G . ~~C ~ y~K~n ~ `~ ~~ IfKAil~-1-- r0~~~ W• qN ~ rO.Ar p.r ~~• ~ ~+O us~ S~+ •,r'»Ir ~u.t O~ ~. p.p : ~o ~.1~ •+~iDt~1H OC(V~NO •. .~1 rUt1 [r. •-~ ~.^ f /M171(IAM O rOwrw ~ aMwDlD tw~ •+/j 7 T 1 '~~~ ~ / 111 !'~ f!~~1~ ~~Or ~/ ZI /O " ~1~~~ ~ ~~~ ~ 0~• ~~~• ~~00• r R~ W~rw r.OV~• G~•I •.~C.'O ~r.~ ~r y (~ O~ rr ~.p.~/P~~ t , ~ / ~I~ ~1~ V i ~V 1 M O Mf (~VSfift Sr~'• ~ ~~ 1 ~ , ' • O 0 1 _ _' o~ *y E~ O~ COtO-+t~ i~ ~ ~ ~ ___ '"_'_ - _ __~_ ~l__ t:~~ o~c~w..• .- •~aar.»c~o o~.o ~~ ) ~ »i ~•sa M~ + Y~ ..ou~ o~ a. ~ ~E~tHKAi~O~+-MED4wt fY ,~~rw~hOw M tiY p0• ~.~D~O~ rw! ~«i11rM.~x~p•:. . . pl~..~p.., D~~~+ OCCY~~fD O~. M~ 0~~~ ~+O Ov~ ~O •~~ C~uft~t~ f•~~lD ~ rOr/r O~• .~•• rOU~ ~ - ~~' t~ M ,» _1~ -- --?~ I7_ ~ ____. --- ~ I- --- ~ ~ . CEtlifiE~--a,w~E ~n.e o~ .n~,~ i S~Gta~tulE oe.n~ o~ •..,~ U~tE S~G 6 ,• o••.•~•~. t~ F~ter Ge€;erson, M.11. 1"~ ~~~ -- ~ l.GJytt ~»/ ~ ttk ~ 7~ ~ ~ ~- '- ---'----- 1~~!~~ o~ ~~ o ..o WwiiiNG ADWESS-CtRtlnt~- -- - -- U~~ l; ~ i ~ t•: z~ t H i? l s h~~ r c~ B' l~~ d. ~r..~ t.• ~s . c. t~ r f i~• 1< i B~r a c h, fl o r i~i~. 334G1 , ,,, ~ ~UfIAI, C~EMATpN. ~MOVAI CE~wfiEfr O~ CfEwu(OItY-N~~uE lOCwi~On o~. o~ w~~ s+•n ~ ~ anun ~ Cremation t~- Kra~er Cal/Crernatory 1 H~ l'c,mE>ano Bf:F1Cfl~ ~'~LOT'1(~3 ' a __. - . . ~ owtE ...o~.,.. e.. .e... ,ruerte.l r~Ow~t ...ti.t •.~n a:~Mess s•nr. .~. .~ . .,..o_.. a. .~ n. .. c .... . 7u .J ~~~ ~~ 3. 1~7ti j~•,. hi;:lf.i-.f;, ~'1 i I,-~s lli i I~.t,r~i 1., :i~~~~i i i~~l•i ti•~.ir t~t !~!~~~ i~l.+ ~, i:' 1~~ V.S. ~612 ~ ECTOY r~• ~ RtG~St~wi 1i~.r~tulf . ~ ~ ' ~~ ~1 ~~~ ! D~rl ~1Ct~~lD ~. ~~~(~1 •1~.~1r~~• 1 J ~:': ~- . i ~ /y?~ - - Hev. 7/76 .. ~ ~ ~ ~~ ~ f: :~ , -t ~.. ~, - . ~~ ~v r.. .,, ~: . . , < < _ . ~~ . ,~. . - i - ~ _ j ~ . . ~ ~ ''^ '" ~ ~ ~ • ~ , . ' - .. -. ~ ~T ~ '' ~ . . ~ _ • ~ . , , " • .., ~ . t . ~ . . • • ~ ` _ •`i . , . ~ - - . . . .~ - . . r ' r'`• ' ~ - c:-:Frrr r~ i;n coi~`r p: y~ ' . _~Y`h~ereby certify Che abave t~ he a tru~_ and correct copy c~f tiie T,ecal Re~;istrar'~ G.t,ecord on file in CF~e l;rou~rd County Ne~ltl~ Uepartment at Fc~rt I,auderdale~ }~lc~rida. ~(G'arnipg-Not vali~ ~nless raised seal of tl e Br~ ~ard ~:~~~ ntv t' alth i~~~ ~t. is aftixed.) ~ ~ ~ + '' . n j~/t~'~~ t . .: .. t • • ~~~=~ ` 1-9-78 ~~~>' . '~_' `'~~t C~unty Heal th 0 Ci cer and Locai fte~;i s,trar C ~Q.~UYh~• • `~-. Q~~GG~ .Q i ~ ~bQ~ ~o,,~2a~ rhief ~1ep uty I,ocal Ne~i trar ~ -2, $' ,~s9 . 1~.0 •'(3K ~`VS, f~Q1l~iak~ ~n~l-, Fl 33y~i - , ~1~393~ 1981 M~~ -4 Pt~ 1- 02 : ~_c (' th1 '" i.llri t~:` S'i~~c~f~R i cis~i rc~a. 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