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02 S' <br /> Yarm 8-329. 2m4-59425384 ` <br /> (USE TWO LINES WHERE NEMSARY, ALL NA�AM TO BE GIVEN I FULL.) <br /> ---_ -----:::------------- � � n'=--rte' <br /> — - t <br /> DATE FULL NAME OF FATHER j <br /> jl <br /> _ -- COLOR � PLACE OF BIRTH � I <br /> NO. OF FULL NAME OF CHILD SE% etc. i <br /> BIRTH <br /> a <br /> ! <br /> 01 ___ <br /> .... .. ... . <br /> Is <br /> I <br /> • <br /> Y.. <br /> � ii 6 <br />