Birth ID:                    

Certificate Location:        
Certificate Number:          

Birth Location:              
Birth Date:                  

Name:                        
Immigrant ID:                
Sex:                         

Parents' Home Address:       

Father's Name:               
Immigrant ID:                GWLD-30JUN1905-3-27-0028 
Birth Place:                 
Age:                         
Occupation:                  

Mother's Name:               
Immigrant ID:                FRAN-20JUN1913-3-2-0024 
Birth Place:                 
Age:                         
Occupation:                  

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

Parents' Marriage Date:      
Parents' Marriage Place:     


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