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B. Cert. 5‘.
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/ YG 320920

.R.

l& 2 ELIZ. 2 CH. 20

CERTIFICATE

 

  

Name and Surname.../...%.‘..'§ ................................  ..... 

Sex ........................................................................................................................................................................ ..

Date of Birth .................... ..

Place [ RegiStfati_<>n .................................. ..BlD.EE.QRD. ........................................................... ..

of ( Distrlct

Birth i Sub»district ....................................  ........................................................... ..
I, ....  ........................................................ ..SuPerintendent Registrar
for the Registration District of. ......................  ........................ ..do hereby

certify that the above particulars have been compiled from an entry in a

<06? 7/
Witness my hand this .....  ........ ..-.-.....day of. ................... ..

CAUTION :—Any person who (1) falsifies any of the particulars n
this certificate, or (2) uses a falsified certificate as true

register in my custody.

  
 
 

 

% knowing it to be /ézlse, is liable to prosecution.
....... ..s..'.Q.. 
x “ “'*‘1r=— -H—— —~—_‘.. .,_—,_~ __

_ BIRTHS AND DEATHS 1e:.;<,-1s1‘1«:.»\T1o.\' ACT, 1574.
CERTIFICATE of REGISTRY of BIRTH.

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 lzas been -(Zuly 7'egz'.s-z‘c7'czZ by me: at Eztt/‘y .’\'0.4Z.i».7
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of my Register Boole

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