Birth ID:                    

Certificate Location:        
Certificate Number:          

Birth Location:              
Birth Date:                  

Name:                        
Immigrant ID:                BELV-15NOV1913-2-U13-0003 ? 
Sex:                         

Parents' Home Address:       



Father's Name:               
Immigrant ID:                ROTT-05NOV1900-0-C-0014 ALIC-07JUN1911-2-2-0012 GULD-18JUL1921-3-U6-0002 
Birth Place:                 
Occupation:                  

Mother's Name:               
Immigrant ID:                SICI-15SEP1904-3-1-0014 BELV-15NOV1913-2-U13-0001 
Birth Place:                 
Occupation:                  

No. of Children Born:        
No. of Children Now Living:  

Parents' Marriage Date:      
Parents' Marriage Place:     


Comments:
                             filed in Book III, p. 46