1985-1989_BIRTHS_MARRIAGES_1980-1989_DEATHS_INDEX

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1.REGORCJ NUMBER =3C.COUNTY 0140 (fommnnweattl� Of RDDR�'l a 3D.CITY/TOWN MAKING RETURN C DEPARTMENT OF PUBLIC HEALTH Mum �+ REGISTRY OF VITAL RECORDS AND STATISTICS 3E. REGISTERED NUMBER H 3 3B.CITYITOWN STANDARD CERTIFICATE OF LIVE BIRTH U U'U"s 123. 1A.CERTIFICATE NUMBER a 3A.FACILITY NAME-IF NOT IN FACILITY, NUMBER AND STREET (DPH USE ONLY) I s viowcizicu 4C.LAST NAME 4A.FIRST L 46. MIDDLE 7.TIME 8.DATE OF BIRTH(Month,Day,Year) H RESIDENCE OF 6A.PLURALITY 91B.Specify BIRTH ORDER(If not single, 160 no PARENTS 2.FACILITY NUMBER D 5. SE (Spec etc.) Specity Ord r.Firey�,st Second,etc.) av M XWWh Abis 9C. LICENSE NUMBER 9A.SIGNATURE(I Certify that th hild was Born Alive at Date and Tlme and 9BB.TYPE OR PRINT NAME I lA 3 E lace t o i z RESIDENCE R 9E.CITY/TOWN T 9 .NO.&STREET 9F. STATE "' 9G.ZIP CODE 9H.DATE SIGNED(Month,Day Year) "- 02X7 P-Ir $ F CwtwPIYVvtm 1 91++..T�TYPE 9J.TITLE S R AE AT-BIRTH ❑ POST-NATAL ❑ CERTIFIER ONLY ❑ MD/DO ❑ GNM ❑ OTH. RN ❑ MIDWIFE ❑OTHER N10A. FIRST 10B.MIDDLE 10C.LAST 10D. MAIDEN SURNAME o M � 1 -� �- O BIRTHPLACE 11A.CITY/TOWN 11B.STATE/GOUNTRY 12. DATE OF BIRTH(Month,Day Year) mwxh soT CA SANM cmH 13B. CITYfTOWN 13C.COUNTY 13D.STATE 13E.ZIP CODE RESIDENCE 13A. NUMBER AND STREET 0 {.W,L3. 'C, to on E (Do not use R mailing address) S Vista 14C. LAST --- File [FNAME 14A. FIRST 14B. MIDDLE W itt �. 16. DATE OF BIRTH(Month,Day,Year)156.STATE/COUNTRYHPLACE 15A. CITY(fOWN 7# L955 Uxbom 17B. RELATJune IONSHIP TO CHILD . I(WE)CERTIFY THAT THE PERSONAL INFORMATION APPEARING ABOVE IS TRUE AND CORRECT. N 22A.SOCIAL SECURITY CARD A _ CITY STATE ZIP CODE --- 17C.DATE SIGNED(7' 77- YG ADDRESS NUMBER AND STREET ❑ YES N mINITIALS e) 22B.RESIDENT COPY T19.SUPPLEMENT FILED(Month,Day,Year) 20.CLERK/REGISTRAR C 18.DATE OF RECORD{Month,DaYESE K 199 INITIALS 21. CLERK/REGISTRAR DPH USE ONLY 22C.CENSUS 251 1.RECORD NUMBER F 3C.COUNTY � E �IIIIIIItIIniUC>Tjfjj of�{BDSflL4nSE3D.CITYITOWN MAKING RETURN tt.B �1 DEPARTMENT OF PUBLIC HEALTHmew C T= REGISTRY OF VITAL RECORDS AND STATISTICS �2 H 3 3B. CITY/TOWN 3E. REGISTERED NUMBER STANDARD CERTIFICATE OF LIVE BIRTH 11 1 1A.CERTIFICATE NUMBER 3A.FACILITY NAME-IF NOT IN FACILITY, NUMBER AND STREET ~" (DPH USE ONLY) NAME 4A9FIRST « 48. MIDDLE 4C. LAST FARM ~^~ L 68.BIRTH ORDER(If not single 7.TIME 8.DATE OF BIRTH(Month,Day,Year) 2. FACILITY NUMBER 5. SEX 6A.PLURALITY D M (S Sin ,Twin,etc.) SpecifyOrder:First,Second,etc.) �,�+Z M + r M C 9A.SIGNATURE(I Certify,that the Ch' was Bor Alive at Date and Time and 96.TYPE OR PRINT NAME ; 9C. LICENSE NUMBER -J 3 E • P ce S ted. - _ RESIDENCE R I'�I� � T 9D.N0. &STREET 9E.CIIY(fOWN 9F.STATE 9G.ZIP CODE 9H. DATE SIGNED(Month,Day Year) I MA 02367 jUm 29, 3M9 157 CM*AW St- "ry0m 1 91.TYPE Cwtificate9J.TITLE - C 8 H X1 AT-BIRTH ElPOST-NATAL ❑ CERTIFIER ONLY ❑ MD/DO ElCNM El OTH. RN ® MIDWIFE El OTHER FDA CL NAME 10A. FIRST 10B. MIDDLE 10C. LAST 10D.MAIDEN SURNAME j Q MSusan .1 7E Wolter -- r- LLD BIRTHPLACE 11A.CITY/TOWN 11B.STATE/COUNTRY 12. DATE OF BIRTH(Month,Day Year) Jia y 3.8 0, 3955 L� �H�u'' H - ------ --- • __�...._ RESIDENCE 13A. NUMBER AND STREET 13B. CITYJTOWN 13C.COUNTY 13D. STATE 13E.ZIP CODE E - (Donot use mai Z9 �� 02649 R mailing address) ///UUU/� �- F NAME 14A. FIRST 14B. MIDDLE 14C. LAST _ A Dwid I iota TBIRTHPLACE 15A.CITY/TOWN 15B.STATE/COUNTRY 16.DATE OF BIRTH(Month,Day,Year) H R tic .3t 3 , 19 N 17A. I(WE)CERTIFY THAT THE PERSONAL INFORMATION APPEARING ABOVE IS TRUE AND CORRECT. 17B. RELATIONSHIP TO CHILD other 22A.SOCIAL SECURITY CARD n &am " 17C. DATE SIGNED(Month,Day,Year) 17D.MAILING ADDRESS NUMBER AND STREET CITY STATE ZIP CODE i ❑ YES ME (If different from INITIALS N a ( 1 ,I i )' item N13 above) 22B. RESIDENT COPY 18 DATE OF RECORD(Month,Day,Year) 19.SUPPLEMENT FILED(Month,Day,Year) 20.CLERK/REGISTRAR - ❑ YES �. ,? -� INITIALS wa 22C. CENSUS 21,CLERK/REGISTRAR DPH USE ONLY - "�- FORM 1146 HOBBS &WARREN, INC, i.