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Sonate Ana Yrost ~ oe Reese : “have OF SAID = _- WAIDEM SURMANE OF MOTHER : . Pace * ; + - 3. Usuat Resivence or Movnen, ch Ceara RESIDENCE oy £6 OF BIRTH: (8) Covst re | 3, Usual RESIDENCE OF MOTHER: © ~. tm CALIFORNIA: pos . - oy. + . oo. as a. ‘CHT OM tow ae NF 2 H «¢) STATE : _ Qu reise CITT OF we wate, wate we ; } Bcktus. Bars ' Haat or ROSFITAL CR TeATITUTIOR’ - - (8) Couns - ey z Anner to ssiteal © “Rf. cD) Civ ony Wontwn cars . FRET oe BOSCIA ON HSTITYTION, G:¥6 STEELT BUURES UB vecatiaa H euIsjox cin Ga yo ' ar, . woe oN . 2 nN = ++ MOTHER'S STAT BerOeE BILITERYY PS : vrg -: Tye, ‘ ow re in Mosritaa Om me TTaTIOR ert Ling, rac commarit svn LO F tT >) secareen Sh4 Drown Street fee Se rrenk Sonius om ‘eld US. tei or : “7 i “et a “Harold Ronnie. Frost tuo Pe ne The within Docu’ cue wnkte vo. Ace ay Tied of tus snr es. ie seston ba noes = - correct copy of he Rat : read } *6- Colon nen. LENGTH OF RESIOENCE IM CALIFORWIA__ Raced fe 17. AGu At Tine o7 THis suRTK 29 in this” office: ry Bowing: path CHRTHFLAC past Iss. BiatHrtac TEST: Livat Occuratio CAL UTED = svat Occuration_i_H4Usevite - UEL L ty JSugustey on Business a Banta pera sess i se cael USTH ‘on Business... HO=@ a na RIE Moat BORN TO THIS — . : f 82. MOTHER'S Malling ADDRESS FOR REGISTRATION NOTICE: ~ — County Recorder in and’ 14) HOW ANY OTNZH CHILDREN OF THB morsra afz NOW UTING — FSe Harold : ost |. __ «Spun Statg of Cc 0s Hu@ @ANT OTHER CHILORER WERE BORN ALIVE BOT ARE NOW f + 314 brown StPeat B cao ie 7 (2.MOM MARY CWLDPEY SIRE DORN DEAD en ae ere el ee nba Rosa, Gallfe pata: - ' Menten Ceerire, Tay § ATTEMDED. THs BIRT OF re CHILO WHO WAS BORM SLIYE AT THE HOUR org a Das 23 OM THE CATE AGOVE STATED AWD THAT _ ELATED TO THES CHILE uw _mothar wie 7 £ IMENP CATION GIVER WAS FYRNISHED gr _ “UATE ROCEWED ay Locat ReGtsTRAl +A IS. 1322 a) ATTERDANT‘S OWN sicnavoreAsAe Thurlow ‘ t “TCISTRABES SIGNATU am Wet ren = M.D, MIDWIFE OR OTHER... Seg Sig —— Date non BJO /44 a =C4 Name ADDED ny anos Senth Rosa, Calif, oo : Dele . - Receateag eee a = : — = i . . =) PRESmaNcr, COMPUCETIONS OF: $i : ; wo, 4- . <8) Otp the Basy Have Axr i i --—— CoRcEmITAL MALFORMATION tf ' &, Lamon, Comriicanions of: 22 GIG st 3 als = . i : oe ocr | _ Bara Ingorrt AQ ____pescaise: ~~ re > Was Twiee am Oven Svarve atu . . - a : . rGn Deviveaer— MAA Sreeatiows: ~ : : tt Oh BO ~ try Waa a PROPHTLATTIC DRUG Use te rea Bast EVES te Yes Srate feoc_ 4 eae eee ee PAR YMENY OF PUBLIC HEALTH . Soe GE TN Shes oun Fae eG SEN ene eet Oe BR, 2 22 ry ~ , a 7 a iam : . 7 - ~ b : . 7 " ‘tl ay SSS Se ae ex NER EN pa Ne St RO a, EE WS Ne et eae SOC ars . ee?