Birth ID:                    

Certificate Location:        
Certificate Number:          

Birth Location:              
Birth Date:                  

 

Name:                        
Immigrant ID:                LTRN-31DEC1912-3-6-0009 PWIL-05OCT1919-3-U8-0009 
Sex:                         

Parents' Home Address:       



Father's Name:               
Immigrant ID:                CHRI-24JUN1897-0-1-0001 
Birth Place:                 
Occupation:                  

 

Mother's Name:               
Immigrant ID:                CHRI-24JUN1897-0-1-0002 LTRN-31DEC1912-3-6-0008 PWIL-05OCT1919-3-U8-0008 
Birth Place:                 
Occupation:                  

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

Parents' Marriage Date:      
Parents' Marriage Place:     


Comments:
                             [sex is incorrect, should be female]