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._T <br /> 'i <br /> i <br /> f <br /> it <br /> f <br /> 2_5 <br /> UNITED <br /> UNITED STATES OF AMERICA <br /> ....................jaf. <br /> I, the undersigned, hereby certify that I am clerk of the.........................of.................................................. <br /> that as such I have custody of the records of births required by law to be kept in my office; that <br /> among such records is one relating to the birth of - <br /> and that the following is a true copy of so much of said record as relates to said birth, namely: <br /> Dateof Birth 1'... ...............----------••---••----••----•-•--•--- <br /> r <br /> Place of Birth----------- -- ---- - ------ - / <br /> y =----------------------- <br /> - t � <br /> Name of Child_ _ --------- <br /> Sex__-�-.J! <br /> -----------------------------Color --------- <br /> FATHER MOTHER <br /> Name ...................... ................... Maiden Name_ ----- 011- <br /> Residence.......... - --_--------------- I , - <br /> u a Residence__ � _-� %��,�2�--- t �' <br /> Place of Birth...... ..... ...... . <br /> Place of Birth <br /> Occupation----- -- •---• ---------- ----------------------------------- <br /> Date of Record-......../--�_..7 <br /> And I do hereby certif y from said records. <br /> L 119itnegs my hand and seal of said.........................of..................... <br /> on _ <br /> Year._/3.2 .._---_ <br /> Vol.----�.a--T........... <br /> Page--- --------------- � C� <br /> { HOBBS & WARREN, INC. PUBLISHERS BOSTON FORM 429 <br /> i <br /> From Page 14 <br /> l <br />