Birth ID:                    

Certificate Location:        
Certificate Number:          

Birth Location:              
Birth Date:                  

Name:                        
Immigrant ID:                
Sex:                         

Parents' Home Address:       

Father's Name:               
Immigrant ID:                MAAS-10JUN1901-0-B-0011 
Birth Place:                 
Occupation:                  

Mother's Name:               
Immigrant ID:                LPRV-17JUL1908-3-11-0027 
Birth Place:                 
Occupation:                  

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

Parents' Marriage Date:      
Parents' Marriage Place:     


Comments:
                             filed in Book 1, p. 189 / [mother's name is actually that of the paternal grandmother]