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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: LCHM-21OCT1895-3--0417 DOMI-29NOV1911-2-A-0014 Birth Place: Occupation: Mother's Name: Immigrant ID: DOMI-29NOV1911-2-A-0015 Birth Place: Occupation: No. of Children Born: No. of Children Now Living: Parents' Marriage Date: Parents' Marriage Place: Comments: filed in Book E, p. 164