ce~tifica te- of birrrh. · pbrents,/;~?--~wpt.org/sites/default/files/mfh_birth_certificate.pdf ·...
TRANSCRIPT
CE~TIFICA_TE - OF BIRrrH. · ·:. ·;(T~'¥:i'Ciutn~:it:~t~30Aaf,Stti :lbtHc.lth Olfr.er or if 1I0ne totheClerlt~f the tow1l,viUagt,(Jt . City ' in .
. . . " · w$ch·theBlrth,dGCutli;andbyhlm to the Register of Deeds of his CountY.) .
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8 •. Sex
4 . . ~me of otherLliVing (born of saIDe PBrents,/;~?--~ »~~ ? / CL-/ff~~d' ~ ._ ...,..--. J v: ./
6. Full nBme of father c<- ~ ~ 'ie? ~ Z--<.2-~ 6. Occupation of father ~~. L..------c::; . 7. Full nBme of mother previous to marriage ~--z--z.-=-z...-e:(.
8. Hour, day of week, of month, and year of birth..:f7 r(:j t::::' a.... ~ .. / . ~~ H _ _ _ __ _ • ~.£-Z; /~ - /Ze ~ t/'
~:r->'4 ' ;7 O . . The place (b), town or township Rnd county in which born~ /~~~
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10. Birthplace of father k/ ~----------------------------------.----------
n. Birthplace of mother ___ --=:.~ __ -=_'_~ ___________________________________ __
12. Any <:lther important informa.tioll __________ ________________ _
Residellced /,7 - c7
..... . ::..:....: \. .: .: . . Dated a1>-t _______ -.,-__ saicl County, t,hi~ }
DC'" ',il" 1!'Wi ________ Iday of ' I ' . , ~ 11)0 .
F. M. SCH.ULZ.
(c) Health O(Heer. "rintft 8P cur Clerk
N GTE_-( a) Stat.e the color so' distinctly that the race nlso may be understood, RS White, Black, Mulatto, Indian, Mixed White nlld Indian, etc. (11) If citt , ill"ert . t,reet and !lumber. (c) Strike ant the worlls not representing the olie sigllingthe return . State nily import,ant facts ill making the return-lion illegitimate birth, or still birth should be 80 specified '
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" .. : J~. ' ·' ~J1.Y(Jther important informatioll ___________ ~------____,_-------" " ' , " " : '
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