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roy Nang OF HORFITAL OA INSTITUTION 7 ROT Wn MOOPLTAL Og (DB) Movuge’s svar sarong oeztvary IM HOSPITAL OF ERSTITU TION . —_ Sreciry Meret & JERS 5. Twix on “FATHER OF CHILD 8. Furr . 9. Cou svanebe shetetel F~ H 1s. ae LOR OR Race_ White 10. Aczar tine OF Tui aun TH a 16 aur. Jean Wheeler . tf. LENGTH oF ResicENce in CaLtForat ° OR Race Nbite 17. Ack AY Trex or txts rh < o ha Mentns oar ‘ i" (82, BinTHPLace — Sealife | 18, ‘Biaturtace___ California hore 193. USUas Occupation 'CRCRER {On Bike ny ee fe. Usuar occupario # 14. inoustay on Business tandard 0 il { 21 Cuitoren Born To Tuts Moriaa: How xs NY CHiLOREN WERE BO ORM DEAD, ‘7. ern ERE " 7s ‘DATED: Sept. 16, 1974 SAN FRANCISCO, CALIFORNIA ’ ca HURST a Ea hla one dpiiee cies ee ego gia 1, we ——UZBONA Lanphear d wat WNARY OF OF EHD a i 2, Phace oF Biatu: enenat. ciT¥ AND COUNTY or if OUTEIO’ City GR fowM Limit, wAItA RURAL (ASTITM TION, Gove StREaT Numace OM LOCATION . SOREN S. cls oar (a) How many Orman CHILDREA OF TRIS MOTHER ARE KOW Living. a “ 8 (> How want OTREA CHILOREM WERE BORN ALIVE BUT ARG NOW DaaD7_ 0. f —i} ‘t Hsenay Cretisy, Twat, {J ATTANOEO THe BIRTH OF HIS CHILD WHO WAS OOEN ALI¥E 4, : TRIS Is 10 CERTIFY ° THAT, IF BEARING THS. 3.SEAL OF. Or PUBLIC ‘REALTH, THIS IS A TRUE COPY OF ‘S DOC | 7-15290 _PF_ 92135 Po, _ | . 7 a hea | | , i Pe by Leer cerge) attr aber 4p. Eo Vita Moe Treg 3801 ‘ Orwsraicr MO REGS T HAR a Xo. s, . / | 5 is? maipen SUARANE oF MOTHES i 3, UsuaL RESIDENCE oF MOTHER: (a) Lunctn oF RESIORACE im CALIFOR MIA: SAN FRANCISCO (*) 3Tar : : rake. MOATES osta «e) Counsr__Marin Count 2 weeks' Tiga BGatne oare 9,603} CITY ca Tow : * i? O4TS1DE Cit: Da LOwn Leta, wate AURAL TAGS MOantua ears _ Jin THIS communtry, wm Strutt aun nvuse gj ve HOrt = , "sete ° é ST aghts zt rast “oa Trae “MOTHER | oF CHILD Ps jkoustry OR BUSINESS 22, MOTHER'S MAILING ADDRESS For REGISTRATION Notice: Edison Avenue = , ; orte i era AT yHe HOUR rellsS5 ae OM THE DATE ABOVE STatED AND THAT 5 6 tre = ee SHE san FRANCISCO DEPARTS UMCNT FILD a THIS OFFICE, DE, ae J. COrry, ue $, DIRECTOR OF PUBLIC HPALTH AND IOCAL REGISTRAR my aa SESE AIEEE i TIT BS OW OF BT COO oer Ret OO Se ed a rr reattgeStu apes! S stapt oe ceed i RE " Peseta re gee any : eT ey Sd em Gotencat ha onto os ‘ dl . Fi + 4S LABO RATORY Ae