Gertificate

PURSUANT TO THE BIRTHS AND DEATHS

  
 

Registration District

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7¢_t_7_,L._ Zfilrtb m the 8ub-District of 
Columns. x 2 ‘ 3 E 4 5
When and where Born. Name (if any). Sex. Name and Surname of Father. Name and Maiden Sum
of Mother.

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3, , Superintendent Registrar for the District offl

DO hereby} (Certify that this is a true 410139 of the Entry, No._/£L_, in the Register Book of Birt
and that ‘such Register Book is now legally in  custody.

witness mg bane this / 64' day of fibguaf u,


of Jfiirtb.

REGISTRATION ACTS, 1836 to 1874.

ii the County of_]Cm2/1*

6

7

8

9

IO

ne

Rank or Profession
of Father.

Signature, Description, and
Residence of Informant.

When Registered.

Signature of
. Registrar.

Baptismal Name,
if added after
Registration of Birth.

/,1/am
Fflrmwéz)

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4.724,...

mm.

s; No.._Za6___._, for the Sub»Dist.rict of

in the County of

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/V07

   

 

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£34.;
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