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q iu : He “ Hi 4 me bet ie = ss 7 ; . a _ ; SY pusrnicr Ho— S80} sieuesaaes "aS ‘" : . . " WAIDEN SURNAME OF BOTHER . ; . g AND COUNTY OF {3 Usual Risiognce oF MotHER: ia} aE Adie FREE BAN FRANCISCO ) cay srata__California 7 years Paurarag Gilt OA TOMS KtMtTS, SATE | - . 2 weeks’ woRTK: " ©. mane ov NOHPITAL OR meen Hospital so gS 48 courrr._Marin County 2 weeks : CLO ee or : md Corte Madera 2 weeks ——____. le _PULA was OF cabo 2. Ponce oF BIRTH: ert om Tow WOE it HEB TAS 08 teat me oe stast aves, LOCANOR . : | #P QUTSia® G177 GS owe Liste. SRITL SURE Teant | ‘Sours eats .! - . ‘hey . : . . , i 1M oe cs) MeTeER a aTav aqroas bt rl. : . "8 MOSMTAL OR inst TUTIO "3 ot Un rte comauniry. -feee, m EIAEET AUD A¥EB o hiadagiAt.d 2 . ais ie ae. 4 Se” See 7 if $0—80Rn eee oe mensas 7: Date oF —_ : ‘Tarpuay ic); er | eee ov Patenancr. BI rh ter * MOTHER oF Care Pree 5 tteteles 8. ON nite 1 ASE AT THe OF THIS pian _2h = Ls 6 1 Je 1 tf. Lanern ov Resiornce in G 1FORMI FPS —_—-; Gekace Wndte 17. Aox at Time oF THIS wam—2 5. . $2. BiNthrLAce__— eaueeen Sts 2 118, Biaturace__California | 13, Usuas Oceuration : aia on attende Ob te. Usuar aan — 5 ee MOUS TRY OR Us eS Ste SS BUSTR TEL ae ee —— o4 at.’ CHILDREN BORM TO Tata MotHEa: Tbe, ran | aa MOTHER'S MATLING AcoREss FoR REGISTRATION Notices - . mrs) How nawe ones exnzau on ree sotace one ow. Arvime rc aot ae 8 Bddgon Avenue " (> tow many ores exnaeee wane pons SAIVE BOT ARE ROW GEAD 10d. Corte Madera 00 : op _ Bees. . + = OFA ——— — HOW BA SRILSRER WERE KORE SEAS : : 7 tal a ee ate ee 23, t Weneee Cantiry, THat !, aTTaMoRS THE SER TH OF THIS CHILO, WHS WAS ROMM’ ALIVE AT THE wour on L355 ay. on THe SATE ALOTE BIATED AO maz F! 24, Dare Receives ¥ By Locas . Real 25. Recisvaan’ 8 Sionatun 7 dass ‘THIS Is 70. CERTIFY THAT, r BEARING THE SEAL OF THS SAN FRANCISCO. DEPARTHENT wa ' OF ‘FOBLIC: id THIS 3s. ‘A TRUE ‘COPY QF TH? DOCUMENT FILTD am THIS OFFICE. 4 le” : “ { ‘ Pe is tae hae @GO : tree ‘ . . . . _ ‘ ° . + pea Sept. 116,)'1974. | ane LFRANCIS J, carer a “' prpgctor OF PUBLIC HEALTH : San FRANCISCO, CALIFORNIA ® o. AND LOCAL REGISTRAR vt ede ‘ et , ty * “on, “4 , i ; aR ST wT a poco"!