Laserfiche WebLink
i <br /> --=� <br /> ffiIIe QIamtttanfasttltll of �Ilttssttcilusetts ........... <br /> ^}- OFFICE OF THE SECRETARY (City or ;kine this return) <br /> bl... <br /> DIVISION OF VITAL STATISTICS ! <br /> (County) <br /> m nty) <br /> LLn STANDARD Registered Ni)N'o. .... <br /> � a 511 Ge CERTIFICATE OF BIRTH ` <br /> W <br /> (City or own) <br /> O ) If birth occurred in a hospital:or institution, <br /> ,,,,,,.....STREET.• •WARD(give:ys NAME instead of street and,,number) <br /> aJ, NO ... Ul.......... 6 ` <br /> In thin community. •yrs If child is not Yet named maks <br /> Mo 'a stay before del veryt In hospital or institution t supplemental report, as directed <br /> 2 FULL NAMCHILD .I.C � [� <br /> F 4 5 Born ALIvn orSTILLBOBI Date �U e T„ ��1•�c?�a <br /> 8 8e= Twin or TriPletT .......... of Birtl► <br /> I If plural 1l1No,born1at,Zudor3rdt <br /> ..W-1.V e (Month) (Day) (year), <br /> ((( 18 <br /> Sa Color Births .... .. <br /> FATHER MOTHER <br /> l ) , rn <br /> 7 FULL NAMEMAIDEN....HIG:,��.1. �{JJ��� rTl.�.....:..1 ae... <br /> NAME PRESENT f 1/•e'�1 L�......... 4'..i <br /> ......... NAME .... iC..�S.y. L /� <br /> 14 CJ.Lp ....................STRE9T! <br /> g •••.STREET RESIDENCE,NO. <br /> RESIDENCE.NO. <br /> CITY OR TOWN a 5 h e�� . <br /> STATE. Q�✓$, <br /> CITY OR TOWN ...........................STATE............ 16 <br /> 10 16 <br /> I <br /> COLOR L� A)GE AT TIME OF 41 <br /> COLOR I AGE AT TIME .. ..,(Y�se) OR RACE .9/k ���'llll ,�!! '' <br /> THIS BIRTH .. (xsnas) <br /> OR RACE ................... THIS BIRTH <br /> 17 J�/ <br /> 11 PLACE /// 8?45o1: <br /> PLACE , ,,, OF BIRTH .. ..••.. w '' (State O!(OUIItry) <br /> OF BIRTH ............... (State or Country) (City or Town) <br /> (City or Town) 16 <br /> 12 OCCUPATION .....!.1 .. Q. <br /> OCCUPATION <br /> 18 f .m. on the date ab• e s ormation given! <br /> I hereby certify that I attended the birth �thhl chB who was born at the hour of � <br /> ...., related to this child ae....�17.�j.�... ..•• ••,; <br /> �}i..kS.. e ... <br /> was furnished by.��.?) /E • . <br /> SIGNATURE OF Cry'`FAL� i•L� y.......... <br /> ATTENDANT ATJ�BBIIRTH . (Namej \1) <br /> ` )) (Physician, _ ) <br /> /../. S/d ee/,,. !. np.' DATE ..�lV <br /> ADDRESS NO. a.�?J... ky <br /> ..............:...... (Day ,. �• (Y <br /> 20 RECEIVED AT OFFICE OF CITY OR TOWN CLERIC ••••• �'(Month) <br /> A TRUE COPY ATTEST: �Stl��:s' trar) <br /> 21 <br /> I,the undersigned,hereby certify that I am the Town Clerk of the Town of Mashpee;that as such,I have custody of the <br /> records of births,deaths and marriages,as required by law to be kept in my office;and I do hereby certify that the <br /> above is a true copy from said records. <br /> WITNESS:My hand and the SEAL OF THE TOWN OF MASHPEE <br /> A TRUE COPY ATTEST: AT MASHPEE,MASSACHUSETTS <br /> Deborah F.Dami <br /> Mashpee Town Clerk <br /> Q/e12 <br /> P.I� <br />