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- | Appfteation for Birth Recor = ° 1974. | | A Oe A, ar {$2.00 fee for Certified Copy} Name Given At Birth Has Name Ever Been Changed _ A Jo _ Date of Birth Father's Name Mother's Maiden Name Did Birth Occur in San Francisco _ For what purpose is this record required Fe v Vor onal LAOL Yotts : . NAME ADDRESS POSTAL ZONE oe Certification No, * SEP 16 1974 - f Date Issued By s Typed Photo ___ \ Las Bits Sit it : i : oe 1M : a 3 Rg 4 ui : raed 7 . oe ve i = te 2 * gee EY ae de aon » Beattie ore AY. 2 Doig eha min hy caieeeals te a Secale xt PNR. ‘ . b Phage we e figs * Kes2et uf ¥ { ; — FG eS mE SO ROS FORE G PRA Beef . re eee Seco Be a ee ange Seow o* 5