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iM-_1/9r.814831
EXECUTIVE OFFICES OF HEALTFI AND T.IU'MAN SER\TI(:fi$
c fi4(:69
STATE DEPARTMENT OF PUBLIC HEALTH
REGISTRY OF VITAL RECORDS ANTJ sTA'I'ISTIC$

COPY OF RECORD OF BIRTH

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Dile ot frittlt TUr(E___,p ?, *t, I Time of Btrtlr **-{-'--"' -- ''-'a- f}
Plere of Birth I,{ ,p4 .r_E
f .,*- l,+r_d .

-srx Race

Fluralirv Birth Orrlet .ffi-'t

MOTHER
-FullNerne.44frt'
---* 4. _ {fntrrrrt{.t-t- ,,fl_E-.Flt-r
EfEt Middle l.rst ' Ivlairtcn

4ge/Dete of Birth -*l--.-*---

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qccupattor: FF Race b; tJ t -r tt

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FATHER
t"ttr't*"tS_furggk_
Flrst

Age/D,etc of llirth Birthnlace

()c*trp'ttiott fiI f,, * Hd. /h.t C

-.lE-1t/H-l-TE-
q.lre of Redord .7-
,FCljal.+r?__a --g:tg-gI-48!rldslsnt i_- *t::*'/-
I, tlte undetslgted, bereby cefiifu thal I atn tbe Reglstrar alVttat.Records and Sttxurtlcs; that as suth I haue cusfody
of tbe records of bttth tequlted by law tn be kept in my otftce; and I do heraby wt{fy t:bat tho ttbot e ls a trte colslt
ftum *tld records.
Wlf/1ff55 my hand and the SJ'dI OIr 7'H[:Itfit ARTMEN/
OF FUBLIC HEAII'il at
ttayofpGfOfrfR tsFj
Boston on thls
tI "5 I'

[fufrq"*----
Reglstru.r of Vital Records and St.rtlstics
Reg. No, R 6 .t _.--.", ,,
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