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HomeMy WebLinkAbout1786 - . . _ . ; - . _ . . . . } ' . ~ _ - ' - ~ ~ ~ ~ ~ . _ - 310~~~ , - : ~ ~ - - ; ~ ~ ~ . - ~ . . ~ . _ . ~ - G~RTIFICAY~ OF DER7H . . Dcp~Aa+twl ol Ilea~t6 ~nd Re6abililatNe Secricca EiTAT[ Fil[ .NO. i . ~.•cvc~.v ~~~r:~~.n~ . F L O R I D A - . ?T?E, O~ /R~NT IN ~~~~~~~~p° - REGI6TAAR'i No. 338 ~#S:: ~ HIMAKtNT INK ~.p~ rwp,~ u~~ SEX OAiE Of DE+.TX ~rOwtr~ ~~T, ' SEE ItAxD{00[ f0l ~~~-~E : $ ~rsrwcrars , Carrinrton G:±_':_~at;a„ :.2~ale du1.a• 22,~ igjp i'~ cotavtr of oFwTn - . . tACE wwm. Mww. ~.t~KU~ w~w~. AGE-i.ii u~oe~ ~ ri.i ~u~~~~ ~ a.. DATE Cf ~iliM ~~TM, s•r, . ~~i 11C. ~I~ICY?1 ~ W ~~~M0~111t~111 rOi. W~l ~~l ~R . r; = 6602 I~e ~ro s. 82 s. ~ ir . R 1887 St. I.aci a - ~ : . TOwN, Ol t t OE~TM 4.~be an ~,.n~ n05?tt~1 OR OiMEt rtST~ T ~u no~ u+wu, aM frr~~ •w ¦ww~ ~ . snca+ ~e: o~ rw ~ . - n- I~'t. Pierco n ~•:s ri P'c•^~~ ?`rr.,.r;a.,~ . STwiE Of WTM ~ r wot M v.~.~., w~re GiIZEN Of WMAT COUHT4Y In~RAtED, KEYER /MR,bED, SVtVNliG SE IM MII~. OM ~MOII~ rwl ~ cow+ni . W+DQY~~EO. DNORCED ~vecr~~ - ~ ~ vw,~~~ioe.~u ~ v~:'~'1:'~~ci U.$.:~. ~1~ e'~~:'1j.C_ 11. 12'22:~c• G~ll~~~a~ . vrMU Nu.xe ~~NyTM MNNEt VSVAI OCCU7ATtON ~w•i c..i o~ roac ea.~ ow~~.o +w~ a Kwp Oi WSa~+ESi Ot u~WST~Y ~ _ ~m~. u a~rw .~wau.o ~vi. ai~ u ~tn.a ~ OV '•O w • - o ~r. unknown Pluri~er ~n. °lu~:bi:~~ - ~ . ~w.-~+. RESWENCE-SiAi[ _ COUh1Y CiTY, 10?rr1, Ot IOUTIOt~ wsw~ cm .~m Sil{ET IJrO NUM?tR ~ IYlC~1T 1t~ O! MO~ F~ ; ~ ~ ~ i ~ 1~~ ~.nC 14C1~7 ~^.t~ C,~.~~~} ~ - _or~da ~u 5,,. Lt_c_o ~k Ft.. P:_~rc. ~ ' /wTnE~-xM+t ~~a~ wOfw! ~ ult M071iFt-A4A1DfN NAME ~ Iw~: - roOU . W~ ~ _ . , _ _ . - ~ / ~s. +r.'d20C}i ~ ~~lA::<<r - u I~ilAll ~ - o ~ _ _ I WO~N1Al~T-N~E ~ ~ i.uktlvG wOGtESS INnl1 O~ ~.IA. ~0.. em w ro.w, er.n. er~ ~ , i~.. _ An2~i.o Gallos;a• ' ~n 1 0 i:. S 3tt~ S 1'i n~-rn i~ '~'2C~[n - fA~i 1. OEAM WAS GUSEO ~Y~ (EHifR OhtY QtiF GUSE IIt tWf fOf e ANO t ~~i,~~~~ - . . _ ( ~ f~1. l A ~~nru. o..sn . o x.rM ' y~~(~ull C~vM _ _ - l~: ` ~ ~ - - . (•1 4' ;,.t:.:. l} L=-u~"'~'. su. ~ L.:•~a r,:.,~ - trJ{C Y,i.-~ ' ' ~~NWI ~ ~ ~i !1 • _ V CONOtt1OM~. 1/ ~~R. ' ' . . r~~tw o~ra [~sl to J (b) - u...io~.n c•rs~ ~m. ~ wa ro. a.s ~ co«ua,~..u o.: lf~llMO fMi YM~~[. " . tT~w~ C~11N t~l~ ` . - . - - " _ ~ IART OME~ SIGNVKANi COr~01ilON5. ~~pT~ON1 (ONiWy(:wG I(~ pl~iM IV~ hOi ~l4T~D 10 4V11 GMIM M IYt ~ 101 AUTOrSY ~ lf YES bl~~ ~~MOIMCIt COM- ;y 1~13 W~1 p~i ~1 IrN 0{t~\rIFIMO 4VS1 _ ~ 1-1 ~t ~ s .E ~ t--t ,w ~ ~ ,ri ~s . _ . , c. V~.loWfl w[GDEr. E [ w1`€~ ~sowrw, wi, HpIJi ?iOW IN)URY OCCURREO or rvn ~w r~~t ~ w?.~~ , rtt. ~s1 ~ _ ~ t - /OYK~D4 Ot 1NO~IEfY1M(D ~ - - . , - . ~ . ~ M tM r.~. nw. ' ~ IMJURY AT WOf7C tUCE Of WRMY.~ .o..i. r.o., aru~., ~.c~o~~. lOCw710N ~ fn~n o~ a.r.~. wo., t~n Oa ~orw, s~.n ~ ~ . tt Isnun rt~ M w01 OwKI W6..~K. 1S?fCN'r1 . - ~ . - . - :4~~~ - ~ _ - + . 7W. - ?x~ ~ ' - 1 , ~ - CE[fYKAtIOH- M~ rt.~ ~TM o.r 'rw ~W 45T yV wYa/M!\ ~I~Y! OA ~ ow/cy~~ ne.r na D[wrH Ottuutp •r rM! rua, a. n.i ~NTf1~1~N: ~~iM M? TlY ~00~ ?Il~ M~M. I~OV~1 ~ o•ft, u+~, 10 1M ulY ~ ~ . ~ ~rtlnDls iwt ' 01 rT [MOrUDG, Ou! . ~ tl~ oru.iio r¦o. 7~ 7 ~ 70 TOtU ~ !Ic ~ O ZI~. JI~. ~.L f0 MI 4~Slil1 S~wt[D. ~ ~ CfliyKwTqN-MfO~Cwl EIUrwNft OQ COtO`iER: oti r~i ~.~~s o+ ae ~o~~ or oi.m r.~ oee~w.n w.s rw~.w..ue oue - - ~ - ~ cua~.to1+ or rwe soo+ awo/ot r.t an~u~e~~w.., ~M .s orw~0~+. aoarM oar _ r~.~~ wov~ . _ . CI~M CCCV~~lO O~ al C~tl ~MD DN W M( UVStlil Sf~TlD. 1:~ wt~77! M~ ~ ~ ? tf~Tif~fe-nµ.f m`t o~ no+n S',~,rt~i~aE . o~r,.t~ o~ .,ni D~tF GrrEO o,r, iw~ - ~ C ~ ~ ~Yilliartt H. Viever, A1f. D. '1:;~ Jl~l•~.tc,,.... • ( i~..~ ~ ~ I~k ~-'i.~-~-v a ~ l 1 c ` ~ Mw4 Cf J i~.tt~ o~ a..o. ..o. Fn ee w... F1 . ~;,~~4 0 ; _ z~. "~$~`~ort`~i~ St. ' i 3 s . - , ~VRUI. pEwNT~pe~t, ~EMOVAI Er~ETE4Y Ot CRiwv~TORY-t~.u+f - ?OGT~Ow ~ em o~ w~++ ~++Te - ~ MKar ~ ! F~ T~i n.~ r-. .r~ ~~•--~F~.,.t? ~ i= Di r 7 ' . ~ 7H- Bul'~.~ 7i?.- :i.. :J~. _ _ 24. v• a._C.CB ~~Y'1C~. ~ i OATE-T ~~swoMm, 1w*, nn+~~ fUn2U4 NO/YtF-NAMF aND AD:..'ESS 11T~111 O~ ~J.O. hf•.~ cm w+o.n, a~•n, :~r ~ . : A` !N. U1:~' G~ 1 v f.h.~3:Ai'7f,~ T:;,~.,~~ ~:7 2~ lT:• Sy' 'i~'~- pir..•no :r-:.~~t.. 'f7t~Kf1 ~ . ' Y~ S~ ib]2 FIF' . iECi -SIGNARit REGIST7~ -S"'vKAfUi1t - . o.u aca~rco ~r ?ow ato~sreaa . - Rer.-ty7o ~r .~`r .,c x. ! ~ ~ ' iu. Au~1st 6 1970 . i F}anby csrtify tfii~ ta be a trus and correct a~y vf t~ie trocet _ r ~ . oce : ReQtttr~fs rsoord ors flk in tha St. t~ucl~ Cocrnty Heahfi ~nri~ ~ _ m~tf at FoA Pbro~, ~brid~. - ~ ~ , ~ r R « ~ . f~ - (VYaminQ: Not va~id unlas ralsed ~sl of the St. Luci~ f 1.£~~~E~ f1~ _-~,~`+'~i - - Cou ty Haa th Dspartment is affixed.) S~ ' r POtiRAS ~ . :x~ , ~ - - J Ra~ ~ Qu~ ~r ~ : , L ( r~, c==..:,u~t c ~;t'-,r,~. _ _ ~ ii' , ~ ~ ~i , ~ . y.a-- ~ _ _ N. D. NJLLER, M. D. - RE' vr .t=1E j ~ L ; ;^.i , : . + - c~o~, ~t~, off~o.~ a~ ~tar . ~Og~~'~5•,~ . _ - ;~~,s~ ~ ~4 ~<F 4 } • ` `~I - ` • ~ - ~ _ ? ~ - ~ ' ~v~:•~ ~ ~ - ~ ~~j-b; ; a i r ~'~f~/~: ~ ~rs,,. , 's I J . ~ ~ ~ ~~~s ~ i~ 1 . ~ ~ ~ ~Y ~ - ~9g ~ - ' i~ - ~ r . ~ - _ . . 31t~ ; ~:~1~ : = _ . - -~tt . ~ . ~ _ ~ aoox~~ _ . . ; , ; . : _ ~ ~ - - ~ - - - - - _ _