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Birth ID: Certificate Location: Certificate Number: Birth Location: Birth Date: Name: Immigrant ID: Sex: Parents' Home Address: Father's Name: Immigrant ID: LAQT-06APR1904-3-SS-0004 Birth Place: Age: Occupation: Mother's Name: Immigrant ID: Birth Place: Age: Occupation: No. of Children Born: No. of Children Now Living: Parents' Marriage Date: Parents' Marriage Place: Comments: