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DATE OF COLOR CONDITION. <br /> NA3IF. OF THE CHILD. SEy. (other (As'Iwill,oi' PLACE OF BIRTH. NA.I[PS OF I'AItEN1'S: <br /> "o. (If it have any.) than Hieaitiiliate.) ` <br /> BIRTH. white.) - ------- -- <br /> 4. Z oGG �`� �'f� l lL'G�Gyr.'-G�'� G,`,J ✓� II ✓?y `G�'Lil .. '�-'C—. �i.[..(i(tiGLYL' Y ✓'PL'�ivv'lam'✓�LYD��ii-i0lzl�-OVLIC{�, .,.F - <br /> Z fLr� 4 �1�G���J�GvZ(�v /� ✓rL y r ,n (vTj <br /> C`"'�'' if✓'` 4",om <br /> . I <br /> I <br /> s <br /> 3 <br /> fill � �/ E mNNP6. . �.. <br /> f {- Mk <br /> ) -9 <br /> YAl <br /> ZI <br /> M10) <br /> I 1 --- <br /> (�li) Male, (F) Female. <br /> } ( <br /> B) Black; (�I) Mulatto; (Incl.) Indian. <br />