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AMERICA ol.P-�.n�t�1�" U ti�� <br /> COPY OF RECORD OF BIRTH <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 birt of <br /> I <br /> 2 <br /> ---•-------------------------------- - . - <br /> and that the following is a true COPY of so much of said record as relates to said birth, namely <br /> Date of Birth....--•-• ................. g <br /> ----- ------- <br /> Place of Birth_lZ_ ( - <br /> �Z'�t� <br /> Name of Child -------------------------- -(a1G- �- <br /> Sex.... vL-�%c,. <br /> Color -----------------------------y <br /> FATHER MOTHER <br /> Name . <br /> ---------------------------------- Maiden Name --- ­- ----- --------------------- <br /> Residence ------ �1, -��'' <br /> Residence__ <br /> . _ _ <br /> - ------------ E ---------------------- <br /> Place of Birth--- ---- ------------ ---- --------------- Place of Birth-- <br /> ------------------------------------ <br /> Occupation <br /> V_-- . <br /> Date of Record-1_• 0.- <br /> And I do hereby certify that the foregoing is a true copy from said records. <br /> SEAL i#nese ri,V h a„� and seal of said of <br /> ^ pis <br /> Year---------------•-••--•-- <br /> 1 ------------••----------•-----•- <br /> Vol........................... <br /> - Clerk ' <br /> Page <br /> HOVBS 8 WARREN, INC. PUBLISHERS BOSTON RM 429 - <br /> From Page 14 <br />