You are on page 1of 1

EFFECTIVE JULY 1, 1982

MARYLAND LAW PERMITS PARENTS TO CHANGE THE NAME OF A CHTLD (W|THOUT A COURT ORDER) WtTHtN 6 MONTHS OF THE
cHILD's BIRTH. BorH PARENTS MUST MAKE THE REQUEST By LETTER & AFFtDAVTT swoRN BEFoRE A dlRRymruo NorARy
puBLtc.
u
z
f
o
F
z
o
o
J
o
L
ol
o^
(llo
Fo
E5
69
oz
2@
.3
,E
,o
L
IMPORTANT DOCUMENT
This Certification of Birth Card is valuable. Protect it.
Division of Vital Records
P. O. Box t3146
Baltimore, Md. 21203 - 3146
2t, 1989
This is a lrue carlilicalion 0t name a[d [irth
,acts recorded ir the Diyisior ot Vital Becords
i/i/illiam Francis
Mary Susan
3417 Glenmore Avenue
Baltimore MD
Peacock
ZI2I4
FILE NO.
11989-23242
Female
TE FILED
17 . 19E9
Peacock
Jr
*."{,;#:k
MOTHER'S
MAIDEN SURNAMET
Hen tschel
DATE ISSUED
November
*f ]]?*ir
S if
,!
T h
j
1",,V i'l I tr.r,i
T*H3$l"l{;}.t
;3rivN
s.H:HlV! ::i{VN
N!CIVH
'l-aall
S.U:H1Otj{
STYH$J
I
o
u
o
Z
I
T
m
(
2
n
?IeI iT
-fi&l *
:.AV ietl+to;rt-i;:;
\"'1:.1!,
"
r
/IJ+ JT::C1
fx E sf'}5 .& * Yrd
0200.91u Ie
.pffi ,erouirltp8
091,89
xos
.o.d
sprocaH
iEI'A io
uo1s1n16
31v3tjlru33
HIUIS v 10N Sr S,H_t
:Ctrof\t NOltVu1Sl*:U
H.!"U!E V Sl SiHi
l.NAUIfiSOe
lNWtuodt1il
I$e,i
d1--;.ldis
:
X3*")YIci
3?*t{}*d
Yri;;;;;;3
,^",
j
olnssl 3f,vd
EFFECTIVE JULY 1, 1982
MARYLAhID LAW PERMITS PARENTS
CHILD'S BIRTH. BOTH PARENTS MUST
TO CHANGE THE NAME
MAKE THE REQUEST BY
E
z
J
I
I
F
z
o
J
o
L
(
o
I
I
o
ct
z
E
o
I
IMPORTANT DOCUMENT
THIS IS A BIRTH REGISTRATION NOTICE
THIS IS NOT A BIRTH CERTIFICATE
Division of Vital Records
P.O. Box 68760
Baltimore, Md. 2 1215-0090
I{ARY SUSAN
PEACCCK
3417
gLENMORT
AYT
BALTO
MOTHER'S
MAIDEN NAME
FATHER'g
NAME:
}JILLIA}I TRANCIS
OF A CHILD (WITI.IOUT A COURT OHDERi WITHIN 6 MONTHS OF THE
LETTER & AFFIDAVIT SWORN BEFOHE A MARYLAND NIOTARY PUB
KRISTGPHE
HENTSCHEL
r
ll}. 2L2,74
PEACOCK