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- NAYE ANO AOOt1ESS Oi CERTIf~ER fV?~vS~GAN. MED~CI?L ExA?N~NERI f ~rW a ar+4
Daniel . Denniso~n ND 1038 E Ooean Boulevard Stuart Florida 33494
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MIJURY AT WORK (Spic,/y 1 pU1CE df /iJVqy-/U Iqny, qnn. ~p~ hCfory. olRC~ IOCATION STIIEET Op R.F.D. MO. GTY OR TOWN STATE
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I hereby certify this to be a true and
correct copy o~ the Local Registrar's
record on file in the Martin County
, Health Uepartment in Stua.rt, Florida.
(Warning: Not valid unless raised seal of the
f ~ Martin County Health Department is affixed.)
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~ ~y~.- . Kathleen Muller, M.D.
• - County Health Officer & Local Registrar
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