Add new Registered Mail Label here $1.

00 mailing stamp here

see example below see example below

:C.-S.-S.-C.-P.-S.-G.-P. Flag of this vessel.

FOR THE CLAIMANT'S-KNOWLEDGE OF THIS LIVE-LIFE IS WITH THIS CLAIM

BY THIS CLAIMANT.

~1 FOR THIS CLAIMANT'S-KNOWLEDGE OF THIS LIVE-LIFE IS WITH THIS CLAIM

:first-middle :last
OF THE LIVEBIRTH-NAME: ________________________________________, ON THIS
1st
DATE-~_______ month
DAY WITHIN THE MONTH-~_____________, IN THE 0000
YEAR-~
_________. BY THESE WITNESSES AND THIS CLAIMANT.

~2 FOR THIS CLAIMANT'S-KNOWLEDGE OF THIS LIVE-LIFE-BIRTH IS WITH THE

enter the county here
LOCATION AT THE COUNTY-~_________________________________________________.
TOWN-~ enter the city here
_________________________ enter, the state here republic
TERRITORY-
~______________________________. :first-middle :last
BY THE PARENTS: FATHER:___________________________________________________,
:first-middle :last
MOTHER:____________________________________________________________________.

~3 FOR THESE WITNESSES OF THIS LIVE-LIFE-BIRTH ARE WITNESSES OF THE

CLAIM OF THE CLAIM OF THE LIVE-LIFE-DOCUMENT:

WITNESS 1:______________________________, WITNESS 2:______________________________,

~4 FOR THIS PICTURE, FINGERPRINT-SEAL AND DNA-SAMPLE OF THIS CLAIMANT ARE

WITH THESE CLAIMS OF THIS FACTUAL-LIVE-LIFE BIRTH:

: PICTURE : : FINGERPRINT : : DNA-SALIVA/HAIR:

__________________________________________ __________________________________________
:AUTOGRAPH-WITNESS :AUTOGRAPH-WITNESS
COPYRIGHT/COPY CLAIM: COPYRIGHT/COPY CLAIM:

____________________________________________________________________________________
:AUTOGRAPH-CLAIMANT-LIFE-BIRTH COPYRIGHT/COPY CLAIM: