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3 <br /> DATE OF 7SEX. CONDITION.R NAMES OF PARENTS. <br /> No NAME OF THE CHILD. (Ag T«'1° °r PLACE OF BIRTII.BIRTH. (If it have any.) illegitimate.) <br /> .) <br /> I <br /> it <br /> i <br /> i <br /> VIII - <br /> i <br /> i <br /> * (M) Male; (F) Female. t (B) Black; (M) Mulatto; — <br /> (Iud.) Iudiun. <br /> 13 <br /> Ilfl(pID4 +.Mxn.xcYsu -x A`�Y <br /> . r — � .-- .<- .. ._ _.. •moi _ <br /> Y <br />