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~~S~ ~AR "2 P 2~~ ~N TH$ CIRCUIT COURT IN AND F`OR
ST. LUCIB COUNTY~ FIARIDA
F~'- ` CASB N0. 86-650 CP
• IN R8: ESTATE OF ~ Tt~LUC~E. t.l:;:~i fLK .
JSSSIE S. NSISON
DBCSASBD
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AFFIDAVIT
STATE OF FLORIDA
COUNTY OF
1. Martin Memorial Hospital filed a cisim against the Estate of
J&SSxE U. NBISON. This was in error. The patient was JESSICA L.
NSLSON, date of birth 3-23-83. We hava no alafm against
3ESSIE U. NELSON or her Estate.
~ 2. Martin Memorial Hospitai hereby withdraws, releases and forever
dissolves that Statement of Claim hereofore ffled.
~ 3. Further Affiant sayeth naught.
Executed this V~S~ dsy of 19$7.
MARTIN MEI~RIAL HOSPITAL
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~ SWORN TO AND SUBSCRIBED ~
BEFORE ME 'PHZ3, ( ~~Sb DAY '
OF f~-~«vwA~, 'l9$7
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