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Births Revistered in the
<br /> -�~ REVISED AUGUST 1971 (ALL NAMES TO BE GIVEN IN FULL)
<br /> DATE CONDITION,
<br /> NUMBER OF FULL NAME OF CHILD SEX As TWINS, PLACE OF BIRTH RESIDENCE OF
<br /> PARENTS
<br /> BIRTH ETC.
<br /> E I
<br /> i
<br /> E
<br /> �. BER
<br /> 3C.CG- "--- UI."iL'tllTtr'�!2
<br /> D LIZ
<br /> r o Bak utab2e =. DEpARTAiE�iT OF FJBLIC FIEALTt;tIS6.s. i 33D TY —r� ETURN
<br /> �y 9
<br /> 2 8 O 3 -- = rT01KN 4AKIN3
<br /> `i <36.CITYlTOWN ! REGISTRY OF VITAL RECORDS AND STATIS`IC, I
<br /> E, L.Qrrautt j
<br /> '` 1 tz�'!rtrU,il! I
<br /> STANDARD CERTIFICATE OF L --_
<br /> I�I~C�1 1�}� 3E.REG:STER=G NUMBER
<br /> Arc-NUMBER 3F,FACIL{rY NAME-IF N07 IN FACILITY,NUM5ER ArJ S' 3
<br /> , �� ,c,-c ONLY; I t BEET J -�'�'
<br /> E r14ME FatAau r2 t1o,6pi'C(.c.
<br /> 3 Cl1ICd.S-UPh 4B.MIDDLE -- --- -. —
<br /> __ t� Scott .LAST ----
<br /> ..
<br /> NUMB ER 0 5_= IBP.PCU'- L-' -1- l sKl�v s
<br /> a ( �p (specifySingle,Y �06.BIRTH ORDER(If nu:sing e- r f J
<br /> L 2 b 9 i IA(.{t-e Twin etc.) Specify Order: Secend.etc.) r. IME S.DFTE OF
<br /> {rv..e I Month,pF:y,yesr) !
<br /> (, 9A.t31- URE C Ce t fy that the him i!:24r 41 i M I Aug. 2 1992
<br /> !
<br /> P b•+a'as 5orn PGS and Tir. B.rYP
<br /> Date �9- E OR PRL J E NAME
<br /> 1 i / ZGY �---r—
<br /> 9c.Ll', NSE raur,l6 'R
<br /> 9D.N .a EEr `�' A-0 Ra�'�+ Gagnon M.D. 3w3i"
<br /> URREtdCE o 9E.CTY/TO4vN r
<br /> E
<br /> 2 2 8r�am6�ebur p t rLi�Y?(:LC12 9r STATE 9G.ZIF COG_ 9H.DATE SIGNED(Month Uay,Year) - r
<br /> 1 0 91 TYPE i MA 0254 1 duy. 12 1992
<br /> ----L ,
<br /> n ----- {
<br /> AT-51RTH I�I POST-NATAL ❑ CERTIFIER ONLY I y� ----
<br /> ;';'�- NAME 7Qq FlRST LJ MD/DO CI CNM IBJ OTH.RN ❑ MIDWIFE
<br /> a Al C9�, { DA QlR 706 MIDDLE OTHER +
<br /> �/� 1QC LA�t
<br /> �) �'� i Keegan Hadr,(;yt_s IDC.MAID'c� ��„a���I,gME
<br /> T it C307r iPLACE 1 SA Cdry/-r __ !'vJtTL
<br /> i i H (6rht, f r)ll3 '.16.STATE/�UNTR'r _---
<br /> L New ywLrL —DATE OFBIRTHr -- I
<br /> -� i A,toi,,Gay.\•:ar) '
<br /> RI�W”, 1a4�U� BERANDSTREEi'— uiie 6, 967
<br /> n"°""9 address, 2 Saddebach Rd, t3B.GTY,'TOWN
<br /> tnA.FlRsr I Na:hie kSC9 rzta.b,P
<br /> F NAME
<br /> i A Jon 146 MIDDLE I ,
<br /> T (+Jh itne_y tac. asr I +
<br /> r _
<br /> i BIHTHP[.ACE—Y'150 M: —_--___ i flabiLCY��J
<br /> 8k7a,S'F_CURrT CARU CSo 158.STATE1COUrffRY --------
<br /> i!
<br /> PrC U.tn Weymouth
<br /> L:t r1 _FI 1
<br /> a u 1170.I IbVEI CERT:F� ; M I rf.CAT'r CF BfFrH(Mmth,
<br /> / T PER. 1A1-sMr=0RMA710N A1963
<br /> Year) {)
<br /> i_'ES (S TRUE AND cCK;;ECT I Sen i 1 9 6 3 t
<br /> ` ---r 7
<br /> IK 11ar_S a 78.R•Ei_AMONSHIP TO CH!F__ "'—' t
<br /> 1'C.DA E SIGNED iMo h Cay,Yra! 17D.M�.UNG [,R� -�
<br /> <PG>,DEYr COP.+ A � !1'fJthO !
<br /> € T 19 9 2 n ddte ent trpmBER AND ST R c; C.Rv� j`
<br /> Au.q. '' STATE — I
<br /> > m m a alxnel ZrP CODE
<br /> ° 15.DkT-OFR
<br /> e ECORD tMonh,cky,Yrar, 7S.SUFP
<br /> 1 . CEMENT BLEU nne;th.Day.Yea i 11.CLERKi REGIu HAF i
<br /> -� YF_S _ z iACC U,Sa 13_l 99� --
<br /> 1 IrATIu 2t.CLSFV,/REGSTRAR UPH uS°OCvL„ I ® !
<br /> i
<br /> a. FORM 1146 HOBBS&WARREN, INC.
<br /> S ,. irk.. .,..,.r: .... _,�;,. ..•.d�•.,•., ,..,r .... .�� - ., .. ... ., ,. •. .,. ..
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