◆ SpookStack

AppMation for Birth RecoM {$2.00 fee for Certified Copy} | | SEP 1 g 4974 | Naine Given At Birth SUE LOWS E ( FOL ya) . , -& Has Name Ever Been Changed . Date of Birth OCIObEg <3 / »L94¥ Father's Name H.@, Goro. Mother's Maiden Name SEAWE R, Owen Did Birth Occur in San Francisco For what purpose is this record required FY Z S mo NAME __Sitpha mt Piacpen/ POSTAL ZONE SL FOR DEPARTMENT USE ONLY Gertificate No. £ G £ é Lg Lf Sinai No. 4) GK Number of rs Date Issued ME seP FES CT: Receipt No. Ie... Photo _ ¢ 205 A ° i. PR a ‘i ar i Balt ae errs Race scat SOS OE rere ae “ity 3 vite any ‘ ela at « ps 2 + So tye fairies oS SAM 2 aterag aur ey wy = > i” £95 . ere ain Ss are