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Form B-329, 2m-8-59-925384
<br /> 9j, lgirOs
<br /> arvitstrub -in t4r J,, of
<br /> (USE TWO LINES WHESE NECESSARY, ALL NAMES TO BE GIVEN LV FULL-) -----
<br /> DATE s Condition, FULL NAME OF FATHER
<br /> NO. BIOF RTH FULL NAME OF CHILD SEX as Twins, COLOR PLACE OF BIRTH
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<br /> ,� Lllr (rummottturalth of Iflar,surllmirthi
<br /> Plymouth - DEPARTMENT OF PUBLIC HEALTH
<br /> I
<br /> (County)
<br /> REGISTRY OF VITAL RECORDS AND STATISTICS
<br /> I t1 1'ly uut'r Ply)nouth
<br /> L} 1 6 STANDARD CERTIFICATE O. LIME BIRTH "
<br /> O fG,:y or To.,) _,, (City or Town making±nrs rec_rn) — "
<br /> ! n Hospital —IMP
<br /> . i r- NAME OF SAL—IF t40 IN HOSPITAL. NUMBER s STREET - REGISIERED N_�iE_a
<br /> �2 NVE i'o,:,u,o;7,11k Nicnael Lorpz
<br /> (; --- I r IN LE. --- T HOLIR
<br /> + 1
<br /> THIS BIRTH DATC-
<br /> f 3 SEX ( 4 SI4G.E.T'tAN BORN FlRST. 5 OF
<br /> SECOND.ETC n
<br /> �I D .,1al e I ETC SPECFY Single SPECIFY ORDER OF BIRTH BIRTH Januar-,, 2' 1483
<br /> !� MONTH DAY YEAR
<br /> FULL
<br /> T, b NAME John Francis. __.. . _ _ _... _.�faee. .............. ..... - -- l
<br /> I•I FIRST .. MIDDLE.. _--- L,S� r ---
<br /> AT
<br /> E 17 BIRTHPLACE ... _ Brighton _ MA• .. . .. . .__.....__... I8 TIME OF ,}% ._.._._...._.._. .___ _-_.—. _..
<br /> R T c TH!S BIRTH
<br /> (`- GTY^.TCWN TATE CR COUNTRY —
<br /> 1� FATFEa MOTHERS __._._____�- ..-. _..—__..__..-....— ...._..
<br /> C-aocC.;Pr: . Gari, !ltr'.Y 9b0C;:uPA7101 Housewife --
<br /> Alice.11Ct' _3} LGp22... .._.. .
<br /> T FInST MIDDLE....... MAKE!+ _._ ... Sf _. ........... .
<br /> N H~-~ AGE AT
<br /> ' E BIRTHPLACEHyannisP A. 12 TIME OF 21
<br /> us R GTr OR TOTOWNS
<br /> _ ._. _... _.. ._TRY R'Y- . .. ..._....................
<br /> STATE OR COUN • THIS BIRTH
<br /> 13RESI0E"3E Pec Brook id. `IasnpeeZa ib 164 �
<br /> �
<br /> I N0 STREET CITY OR IOV/N ... COU v�.. Y.. . .'�..:?:. .,. �:i.A •CO(S............
<br /> .
<br /> C I (DO NOT USE MAILUr,^ AD ^ESS, ..._............ .....
<br /> _...
<br /> i4 `ERTIFIER 15 INFORMANT
<br /> M.D. -ATTENDANT AT BIRTH - POSTNATAL ONLY I certify that the information appearing a.;ore is true and correct
<br /> C ATTL-NCANT-IF(TH„E.a Sfi N 10 D -� AT'i ENDANT-C N..N. ,
<br /> o /S gnat�re:Pnys.cnn or other attendant) (Si ature /X)
<br /> ) '
<br /> __. Sanford Leslie, `!.D.
<br /> � �Satner J v
<br /> ... (Pant o-!ype❑aiv Chapfor w,Acts of 19591 ...._. .. ......... .
<br /> (Reiati..rd.,:p) {Date)
<br /> 1 _1.] CCUrL J L. s Ply_, out s...y ..
<br /> (Address) SPre?!i�,alin
<br /> address 1n from Item#1a)
<br /> L_ 9 :c A �°
<br /> is RECO IN SUPPLEMENT vy3 7or� -''a:
<br /> CLERK. 1 17 tg �,r�/'.'>� r^ 3 d
<br /> } 3 FILED z
<br /> OFFICF, A ii iv
<br /> i -- l R REGISTIRT11-
<br /> r-
<br /> _ Form R-4A
<br /> tA.STATE/COUNTRY 49(I mri awfum of�assuousetts "-
<br /> _....._____ ._.-.,__._-_--.__.___
<br /> 2A.CITY/TOWN MAKING RETURN
<br /> PRINT C S DEPARTMENT OF PUBLIC HEALTH Ma ShT322
<br /> m REGISTRY OF VITAL RECORDS AND STATISTICS __----__ -.q -_•--
<br /> LEGIBLY OR � � 2e.REGISTERED NUMBER
<br /> TYPE WITH H C tel ; RECORD OF BIRTH
<br /> " PERMANENT l g OUTSIDE OF RESIDENT 2C.DEPOS140N NUMBER -- ----- - _
<br /> BLACKINK. d SEOUL 1
<br /> THIS IS A L NAME: 3A.FIRST 3B.M1r=-1 E 3C.LAST
<br /> PERMANENT KYLA DOO SUN SLAVINSKY
<br /> TEI. _.._
<br /> - D 1A (S PLURALITY (Sp BIRTH ORDER(Bnot single, 6A.TIME 88.DATE OF BIRTH(Month,Day Year)
<br /> RECORD. 'FEMALE (sp�iy single,Twin,eta.) (specify order First,second,etc-)
<br /> ae.COLOR
<br /> ___ M
<br /> --- --- OCTOBER 3 1983
<br /> IN NAME: 7A.FIRST 78-MIDDLE 7C.LAST 70.MAIDEN/BIRTH SURNAME
<br /> OLA
<br /> COITIV
<br /> T BIRTHP CITY/TOWN 8B.STA 9.00CUPATK)N
<br /> 10.AGEMATE OF BIRTH
<br /> H BOSTON MASSACHUSETTS
<br /> _ E RESIDENCE 11A NUMBER AND STREET 1950
<br /> (Do rxx Lm 11B-CITY/TOWN 17C.000NTY 11 D.STATE 11E.23F&E 12.COLOR/RACE --------
<br /> R
<br /> - --- _--__—
<br /> R ) 62 EDGEWATER DR. MASHPEE BARN L
<br /> -----
<br /> F NAME 13A.FIRST 138.MIDDLE 13C.LAST 14.COLORACE
<br /> T `TOS PAUL IRSLAVINSKY -----
<br /> ____
<br /> E BIRTHPLACE t5A CfiYlTOWN 758.STATE/COUNTRY 18-OCCUPATION 17-AGE/DATE OF BIRTH
<br /> R BOSTON MASSACHUSETTS ITG
<br /> 181lWWEOFDEPONEMfS7 188.ADDRESS 18C.RELATIONSHIPTO CHILD .947
<br /> H 170 Ty'HISTLEBERRY DR MOTHER
<br /> 4 T
<br /> '
<br /> FATHER
<br /> JOHN P. SLAVINSKY 170 W'HISTLEBERRY DR
<br /> .....
<br /> itiIARSTONS MILLS, Mme.
<br /> to
<br /> C The above record with reference to the evidence and
<br /> deposlbon(s)on the reverse of this form has been entered upon the *.<
<br /> L birth records of the City/town of MASHPEE in accordance with the provisions of General Laws,
<br /> 1 4 Q r and attested c
<br /> E Ch,48,S.1 B on MAV Y� opy of this form sent to the Commissioner of Public Health
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