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1 <br /> i <br /> j" <br /> I <br /> I <br /> Form R-54. IOM-4-59-925160 <br /> j <br /> The (foramanftiralth of fflaosarhasrtts N° 2 6 8 6 2 5 <br /> JOSEPH D. WARD <br /> SECRETARY OF THE COMMONWEALTH f <br /> DIVISION OF VITAL STATISTICS <br /> 4 <br /> Y <br /> COPY OF RECORD OF BIRTH <br /> I, the undersigned, hereby certify that I am the Secretary of the Commonwealth of Massachusetts; <br /> that as such I have custody of the records of birth required by law to be kept in my office; that among <br /> such records is one relating to the birth of <br /> tdC S <br /> and that the following is a true copy of so much of said record as relates to said birth, namely:-- <br /> Name d 1� <br /> f � tll� ate s <br /> Date of Birth e4 e, <br /> I VTl&P$3Place of Birth P jy d„f j <br /> i <br /> Seg /�/ �� Color <br /> I + <br /> FATHER MOTHER <br /> J <br /> Name /, . / /t C/ Maiden / � ) A�! 0 <br /> (. !`'f Name �2 a, O ey <br /> Residenced Residence J' <br /> Birthplace a,C Birthplace <br /> P"v OM <br /> Occupation d,b D re y Occupation <br /> Date of Record <br /> And I do hereby certify that the foregoing is a true copy from said records. <br /> WITNESS my hand and the GREAT SEAL OF//HSE COMMONWEALTH at Boston <br /> on this /6 day of ! !/D!J t� 19 "g <br /> vV I' <br /> ' � <br /> a y JOSEPH D. WARD <br /> Secretary of the Commonwealth <br /> 6-l� Year ...........�.. <br /> ` Vol. <br /> d <br /> Page ......................... ....... �. <br /> No. ................................ .......... <br /> V' <br /> From Page 13 <br /> �a <br /> _ I <br /> 1 <br />