Professional Documents
Culture Documents
CT 0159578
T'own
Of Lexington
I
Form R-3 01012011
2OU024446 289
?
Sa MALE
I
--
! ..
1
I
MAY 01,2012
12:45 PM
SINGLE
---
jo
Middle Surname
-LORENTZEN
- - -- -- ----HAN
:
Date ofBirth AUGUST 14, 1965
lE Binhplace
Middle
550 LOWELL STREET, LEXINGTON, MA 02420 Cenifier Name/Tille Type CERTIFIER ONLY RICHARD J ANGELO MD
Lie.1I
Binhplace Resident e
Surname
71188
...
I,,r-'
-----
r..=7
I hereby certify that J hold the Office of Town Clerk of the Town of Lexington, in the County of Middlesex, and the Commonwealth of Massachusetts, and that the Records of Births, Marriages and Deaths are in my custody, and that the following is a tru e copy from the records as certified .by me.
ofLexing ton,
Y a,
Town Clerk