◆ SpookStack

+ TENE mB Aelia ik Spemtelen oe ee ES o arene cin th) tag te rmectsntitstietnatctns ‘st eet epee : . he le Ma Sn ltt erm Ae at ae ES aKa ! { { . vA Distaicr No __ 4953 ——-REGtSTARS 3 KO _130// _ _ Baldauf 3 15 ae SATE OF CHILD MADER XUARARE OF MOTHER _ a ee The within Document Is a Soncms 3. Usual RESIDENCE OF MOTHER, TAY LENGTN OF RESIDENCE ' correct copy of the record > PLACE OF Bigte = «4 Coustr ee sm CALIFORNIA: Sebastopol | California 13 '. in this office. a, C-TF oR toe (B} STAT If CUlbise Cast Oe Tee Ls, Werk Puma, as rey soutad past : RABE CE WOSPITAL CM IRSTETUTION | {€) CovarrT. Sonoma 9 ATTEST: {3! “ fF fe Drive Hos (bd) CITT O% TORR Honte Rio is ea VLU Ej a pig TTP SE bm GSP iihy CR IMS IE deem. $34 SUMCET RVRRCM CR LOCATOR $f OVTSSOE Cily GR 1Oms EtBISS, Bate RURAL tiaea SORIKE pat? ‘ > MOTHER'S Star OxeDeE DTLIVEAT: o < : : ; HERB SHYVER, IR, Ty ~eserTas Severe BY ig sais commune ¢ (b> STREET AND KURDX P. O Box 3 County Recorder in and for Sanoma - erat MT . ey aN of California 1 5. Tex ot If SO—Boxn I 6. Nusace or Mommas 17. DATZ OF it " Re vole Ho TesPLeT__ st zo—__1 OF PREGNANCY, ¥ sixn__Mareh 694A OF uty nec i A Ax ba ' ar FATHER OF CHILD MOTHER OF CHILD 3. Alfred Frederick Bohny 13. FULL yee 7 | Mneew Juliem Baldsuf TeAGs 16. CoLoR Bhite lg ace._MS O10. Ace ar aa TMS OSRTH. . cESSTK OF RESIDENCE IN CALIFORNY OR Rack ETF, ACE AT tome OF Emit BIRTH 18. BiIRTHPLAC teeriand Veaas RUT KS Cara Q 19, Usuat Occuration_ HOWROWALS Caretaker Sane Cap Qwn Hom _ ‘4 DUSTRY CR BUStNEssS "Zi. CAMLGREN BORN 10 THIS MOTHER: thane eo . PerkFLaAc S me . SL AL OCCUPATIO 20. INDUSTRY OR BUSINESS. 22, MOTHER'S MAILING ADDRESS FOR REGISTRATION NOTICE: & ' j & HOW RAST OTRER CHILDREN WERE GORS ALIVE BUT ARE RCW OBAD: P. 0 Bor 335 < Pe Sa ‘ LE @ MAST COILD2ER MEAL BORK OLAS. ¥_ Monte mids oe —_ - AS eS ees Bz: Heenay Caarise, THAT 1 ATIENCED ING BIRTH OF TRIE CHILD WHO WAS BOAN ALIVE AT THE KOUR OF Bia a. on rhe DATS ABOVE STATED AKO TKAT i! FF ‘§ _Mre a RELATED TO THIS CHILD 3 |other : ; ATTENDANTS O@N as =" Se . B.D, MIDWIFE OX omen MeDeo oat Saxe 74 avoness, BObastopol, Californie *. ® &: HOW MANT OTHER CHILOACH OF THIS MOTHER ARE ROM LIVING? L.te Rectiven ey Loca REGIsTRA =. 5.STRAR S$ SIGNATUR tN Newt Aporo_ er tare Riviatace a. - 4s FOECSANTY, COMFLICATICNS OF: _None > — . . cag acl ae vans sy ‘ it $ {£1 D0 THE Bawy HAVE ANY i ad CORGERETAL ancroanationt 2a orscstar: Hone z ‘ Ate pi Lease, ComPMICATIONS OF: None - oa eh _inouceo- BinTH insvny_ 28@ pc senine: a Hons — te en , Wes TMAneE 4% Orta Ry Scatg au =. ‘oa Datieie rN OPERATIONS - Rone - ee 1F) WAS A SEVOCOCICAL TEST BADE FOR STPHICIS IN THIS vom YOu . 113 Ge ao os. it Ys3 Hay a Peoreyractic Geve aS 4:3 vor Nitrate _it Vas Stete Dave STATE OP CALIFORNIA CERTIFIC ATE OF LIVE BIRTH U. S, DEPT. OF COMMERCE . i 24RTMENT OF PUBLIC HEALTH BUREAU OF THY CENSUS IF SO, AT WHAT PERIOD OF CLSTATFICN’. if KOT, WNT MOTT. + we