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{$2.00 fee forCenified Copy) Name Given At Bith__ DOAN ANWE WIEDER Has Name Ever'Been Changed_ JQ) = . — ‘ Date of Birth__SUALE, %, IG HS Father's Name DWAR “OSE ft Wi ELDER Mother's Maiden Name Po! A Did Birth Occur in San-Francisco _— _ rd aa or Was tie For what purpose is this record required. FAY) ILY R ECO RDS f) FOR (DEPARTMENT ‘USE‘ONLY Certificate No. . 72 & ~ #¢ (Certification No. u Receipt No. SS 9A Typed 1505 A