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1. RECORD NUMBER 3C. COUNTY i4t Tomrnumwll:ttltll IIP A80"it 011.0 tts 3D. CITY/TOWN MAKING RETURN <br /> C DEPARTMENT OF PUBLIC HEALTH <br /> m <br /> - tREGISTRY OF VITAL RECORDS AND STATISTICS <br /> 104022 3E. REGISTERED NUMBER <br /> H 3 U 313. CITY/TOWN <br /> STANDARD CERTIFICATE OF LIVE BIRTH <br /> 1A. CERTIFICATE NUMBER 3A. FACILITY NAME-IF NOT IN FACILITY, NUMBER AND STREET <br />�_- (DPH USE ONLY) I 70 <br /> NAME 4A. FIRST 4B. MIDDLE 4C. LAST I <br /> L <br /> FULL NAME OF FATHER 2. FACILITY NUMBER 5. SEX 6A. PLURALITY 66. BIRTH ORDER(It not single, 7. TIME 78�D.A>TE OF BIRTH(Momh,7Day, <br /> ieYear) <br /> D <br /> (Specify Single,Twin,etc.) Single Specify Order:First,Second.etc.) 6:46a•M . NoveTuA:J:. 8t .L7U v <br /> - i NAME 9A. FIRST 9B. MIDDLE 9C. LAST 9D, SURNAME AT MOTHER'S BIRTH <br /> Marriage 0 Stazarme i Dolores 1 Ai 'er Beat': �-- <br /> CP-Xt- f'CELte T BIRTHPLACE 10A. CITY/TOWN 1013. STATE/COUNTRY 11. DATE OF BIRTH(Month.Day Year) <br /> File. H P1 rout-L I 11AA 12/24/60 <br /> - -"--- I E RESIDENCE 12A. NUMBER AND STREET 12B. CITY/TOWN 12C. COUNTY 12D. STATE 12E. ZIP CODE <br /> Do not use ^4 <br /> 2 � R ( x Tv= �.C.fCl49 <br /> � o mailing address) 7Q C1at�lise bane A.�Lsh�aee Barnstable 1.'.�� <br /> i VITAL A NAME 13A. FIRST 13B. MIDDLE 13C. LAST <br /> I � T EK3]eSt Paul �At P.r 't <br /> _-- --- -- RECORDS H BIRTHPLACE 14A. CITY/TOWN 14B. STATE/COUNTRY 15. DATE OF BIRTH(Month,Day Year) Ili <br /> E <br /> ✓�N)� __ c�� pl __ --- AND R Wobam I MA 2/8/57 <br /> p 16A. I CERTIFY THAT THE INFORMATION.APPEARING ABOVE IS TRUE AND CORRECT 16B. RELATIONSHIP 16C, DATE SIGNED(Month,Day,Year) <br /> C) <br /> -- PEN N 1 N I lad 11 qq STATISTICS n (SignNiothnr ature) 4/24/87 <br /> - 6i11et` A 16D. MAILING ADDRESS NUMBER AND STREET CITY STATE ZIP CODE <br /> (R different from }t <br /> P T Rem/12 above) <br /> -- C 17A. TYPE 17B. TITLE a <br /> E ❑AT-BIRTH ❑POST-NATAL ❑CER IFIER ONLY ❑MD/DO ❑CNM ❑0TH. RN. ❑MIDWIFE ❑OTHER <br /> T 17C. S PE OR PRINT NAME(CH 46, SEC 3&9) 17E. LICENSE NUMBER <br /> 1 TToni P nc1al-1 . <br /> F <br /> 1 17F. NO. &STREET 17G. CITY/TOWN STATE 171. ZIP CODE 17J. DATE SIGNED(Month,Day,Yes) <br /> R 71 Seaboard Lane nn <br /> Hyais, 02601 -•_-_-- <br /> 'L 1 18. DATE OF RECORD(Month, Day,Year) 19. SUPPLEMENT FILED(Month, Day, Year) 20. CLERK/REGISTRAR <br /> RR 2 43 40 <br /> 22. CENSUS 21. CLERK/REGISTRAR DPH USE ONLY <br /> i <br /> 1. RECORD NUMBER3C. COUNTY elle (�IImmtE D <br /> unwaltf l ttsstttllnsletttt 3D. CITY/TOWN MAKII` PI <br /> C m Barnstable DEPARTMENT OF PUBLIC HEALTH <br /> 104023 REGISTRY OF VITAL RECORDS AND STATISTICS Mash pl <br /> 3 0 3B. CITY/TOWN 3E. REGISTERED NUME <br /> H s STANDARD CERTIFICATE OF LIVE BIRTH <br /> ( <br /> 1A. CERTIFICATE NUMBER 3A. FACILITY NAME-IF NOT IN FACILITY, NUMBER AND STREET <br /> (DPH USE ONLY) Orchard R ® <br /> NAME 4A. FIRST 4B. MIDDLE 4C. LAST �4d1 <br /> L Dari f <br /> 2. FACILITY NUMBER 5. SEX- 6A. PLURALITY 6B. BIRTH ORDER(D not single, 7. TIME 8. DATE OF BIRTH(Month,Day,Yea. <br /> D (Specify Single,Twin,etc.) Sjng1 Specify Order:First,Second,etc.) 5.55 A M I November 9 19� <br /> Marriage MI NAME 9A. FIRST 9B. MIDDLE 9C. LAST 9D. SURNAME AT MOTHER'S BIRTH <br /> Certificate ° Coombs Linda <br /> on File T BIRTHPLACE 1OA. CITY/TOWN 10B. STATE/COUNTRY 11. DATE OF BIRTH(Month,Day Yea�Y <br /> H Oak Bluffs MA August 24 1 <br /> E RESIDENCE 12A. NUMBER AND STREET 12B. CITY/TOWN 12C. COUNTY 12D. STATE 12E. <br /> Census R (Do not use Orchard 1�i, y <br /> o mailing address) . Orchard 1Vd a Mash e I Barnstable I MA 1 0i <br /> 1 � A NAME 13A. FIRST 13B. MIDDLE 13C. LAST <br /> T <br /> Melvin I Coombs (' <br /> LOCAL E BIRTHPLACE 14A. CITY/TOWN 14B. STATE/COUNTRY 15. DATE OF BIRTH(Month,Day year <br /> CLERK'S R Barnstable MA January 30 1948 <br /> I= p 16A. I CERTIFY THAT THE INFORMATION APPEARING ABOVE IS TRUE AND CORRECT 16B. RELATIONSHIP 16C. DATE SIGNED(Month,Day,Year) <br /> COPY F (Signature) <br /> A Mather <br /> `r M 16D. MAILING ADDRESS NUMBER AND STREET CITY STATE ZIP COD y't <br /> aftia LSI \w'N C C 4 CM�i�1 N (if <br /> different from y 2649 <br /> JI <br /> V d a �'V 4w T/,Y .7 T ftam/12 above) p'O �X 63 Mashpee Q MA <br /> 17A. TYPE 17B. TITLE <br /> E ❑AT-BIRTH ❑POST-NATAL ❑CERTIFIER ONLY ❑MD/DO ❑CNM ❑OTH. RN. ®MIDWIFE ❑OTHER <br /> T - I <br /> 17 . SIGNAT RE � 4 17D TYPE OR PRINT NAME(CH 46,SEC 3&9) 17E. LICENSE NUMBE <br /> F NSA <br /> 1 17 . NO.&STREET 17G. CITY/TOWN 17H. STATE 171. ZIP CODE 17J. DATE SIGNED(Monte,Day,veer) <br /> R 157 Center St. Pl ton MA 02367 NovenTber 14, 1986 <br /> 18. DATE OF RECORD(Month, Day,Year) 19. SUPPLEMENT FILED(Month, Day, Year) 20. CLERK/REGISTRAR <br /> R <br /> I <br /> 22. CENSUS 21. CLERK/REGISTRAR DPH USE ONLY <br /> t. <br /> r <br /> t <br /> f- <br /> III <br /> II <br /> 1 rSvlr 11 <br /> VIII;i <br /> t� IIS <br /> ------------------ <br /> I <br /> __.-._ fl+I'i <br /> rt <br /> III� <br /> a' <br /> fit <br /> Ili l <br /> gyMysh+°#: <br />