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o we “st | 4902 | Dierrict Noe nacist ade: ame. Merilyn Louise Miller er e (0) CITY OA TOwR Jha RAMEE GCE Carle MAIDEN SURNAME oF moTnee wee = pg = . . , = : 3. Usuat Resivgnce oF Motsen: (ar Lewetn oF ageipcags ot PLACE OF BIRTH: (a Count. Sonoms ~U im CALIFORNIA, i “- a Dre a> CITY OR 1O8N. te POU, «Bish e]- 13 ‘ 4B) Star x fF PVISICE C117 O8 TOMA GimiTa, BRITE BUMAL | . TEAas oaTee ne . cy) NAME OF MOSFITAL OF INSTITUTION y (¢) Counst, [ o fy b Te wot re SchPitae om ce ETiwtrom, Give ETALCT AU Of A0tation | EF DUTSIOn tsrt oR tone Ligirt, waita AGAAL y¥kagy Qoatad oats Di MOTMER'S STAY BEFORE OCLIVERE: 4 ‘ I" JN HOSPITAL Sronthh ae «C8 ae COMMURIT TY, A [cap Srvcer ano owes MPO . . 5. Twin on IF So— Born ) G. NomaccorMonyns ||?. DATEOQR = ti (i‘“ é™SC™*™*~™S "> : - 210] Triryer, 19120. or Pasonancy—he Breath Git A * “4° a , : eee ee 1 Bm.) a. — at AS 4 ~ FATHER OF CHILD MOTHER OF CHILD . Fun . Nawe__f ol z 1, COLOR er te "y OR Rac JO. AGEAT TIM OF THIa SIAT Ft reaag . LENGTH OF RESIDENCE IN CALIFORAI 18. Futur ; AIDEN Virginge Mae Hotte , 16, cou on : ace_white 17. Acmat tema oF THIS ore pavisy Coed “r eae, 7 BOMIHE oats | I ; | 1a Ls 19. USUAL + Décvranon Housel fg —__ I 2. BIRTHPLAG « oF tls E- 18. pirrnriacn_—_—_ _—Town ————_ i} 3. USUAL OccuPATIO : i ; ¢._InpystRy oR Business___ 1 QP S@10 if : 21. CHILDREN BORN 10 THis MOTHER; 4 "% Y 4a) HOW MANT OTHER CHILOREN OF THIS MOTHER ARG HOW LiTINg aor) tt (9) HOW MAKY OTHER CHILDREN WEAN BORN ALIVE BUT ARE NOW DAD ste > 33 3 : fy f} ee ee 7% ace Re F THIS CHILD WHO WAS BSORM ALIFE AT THE NOUR or23 552 5. GM TNE DATE ABOVE STATED ANB THat THE INZQAMATION GIVEN WAS FURNISHED BT. LATED TO THIS au wMOEReP 74. Dave RECEIVED By Local RecistraR Maran S. 1R44 fl arrencanrs Oua sromatuee_Aode Thurlow —_____: £5. REGISTRAR’S SIGNATUR al: =}¢ 6.D,, Mipwert oa ormen__KiaDe vate sicxnmfag ah ° ae t BD [ps H aT PRY £) HOW WANT CHILDREN WERE PORN PEADT. _—— ————— a 73. } HERESY CERTIFY, THAT 1 ATTENDZO THE BD aitr ¢ <6. GIVEN NAME ADDEQ,. pr. Abones: ag Date ee __ eEeIeT EAR ie rape reifnge ery grrr — a semper sage ania ——_——<— : 2 “7. Ch) PRERMANCT, COMPLICATIONS OF. etaiel. ' , ~ chy Dip Ted Baay Maye Any no COnCEMtaL MALFOMMATIONL ..._._ DaacRiag, ¢R> Labor, COMPLICATIONS OF KEM Rd ahr DO 3 lor | no_| 8 EE :\- a $I cet. | nth Tatu : (€} Wat TWERE AW OPER STATE ALL 4 . FoR Oruvenr— ROS Sranarionse BM Oi rir ; dis "aah i a <P> WARA femoioercat TECT GADE TOR iin, 2 FMS OTR ER ee (D>) Waa & PROPMYLACTIC DAG Ulan in The Baus Erste TF 80, at WRAT PERIO® OF GESTATICN oe. Iv Yaa, Stave Baus 1 (ie i ‘42 4 ret Ot Wy WoT, WHY NOT —— ee STATE OF CALIFORNIA cases _ CERTIFICATE OF LIVE BIRTH ) us DEPT. OP COMMERCE