Birth certificates and marriage certificate, copies

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ORIGINAL

IN

SECURE

~r; r ; T O ~f.~~~'~ TH4T TH ( 4BOVE IS 4 TRUE 4NO CORRECT COPY , , ~ ((~Ti riCAT( 'ILlO IH TH£ O''ICl O ' TH£ DIVISION

or

PuBLIC

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STATI~TIC~. Sov~H OAJCT-4 STATl ()(~ARTio4ll'fT O' H!:AL.Tl4.

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~JBLIC HeALTH STATISTICS

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STORAGEA

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'FEDERAL SECURITY AGENCY

PUELIC HEALTH SERVICE

1. PLACE OF BIRTH

a. COUNTY

Weld

'I I'·

STATE OF COLORADO

CERTIFICATE OF LIVE BIRTH

REGISTRAR'S NO •.... ).':/.. ... DIST.

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244

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2. USUAL RESIDENCE OF MOTHER (Whero does moth.or live?)

a. STATE b. COUNTY

Colorado

Weld

b. CITY (If outside corporate limits, add RURAL)

OR

c. CITY (If outside corporate limits, write RURJ\.L and give township)

OR ' ·

TowN

Gre~ley

TowN

Greeley

c. FULL NAME OJ.' (If NOT in hos~it&l or institution, give street

HOSPITAL OR addrc:\s or locat1on)

d. STREET (If rural, give location)

ADDREss

922 12 Street, Greeley, Colo.

INSTITUTION

J."C:HILD'S NAME a. (First) b. (Middle) c. (Last)

(TYPE OR PRINT)

WILLIAM

FARR

5 b. IF TWIN 0 R T R I

PL

E-:::T=---:---=-6.--=D::-A::-T==-E ( M=-o-n-:th:-:)---:(: D:-a-y-:-)- -(-:::Y:-e-a...,.r)

(This child born) OF

5

26 1910

1st 2nd ( ) 3rd ( BIRTH

SEX

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Sa. THIS BIRTH

Single ( ~ Twin Td!>lot ( )

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Male

FATHER OF CHILD

a. (First) b. (Middlt.!) c. (Last)

Harry

W. Farr

White

9. AGE (At time of

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10. BIRTHPLACE (State or - - . --:1-:-la-.-·usirAL llb. KIND OF BUSINESS

OR INDUSTRY this birth)

22

YEARS

12. FULL MAIDEN NAME

14. AGE (at time of this I

birth)

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22

YEARS

17. MOTHER'S

SIGNATURE

I hereby certify that this

child was bor'.l al~·e on the

dat stated above

at ... : ...

8 .

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A

M.

19. DATE REC'D- BY LOCAL

July

6,

1910

STATE OF COLORADO }aa.

County of Weld

forei·gn country) OG,CUPA'UON

Colorado

Proauce

vea.ler

MOTHER OF CHILD

a. (First)

Hazel

1 J.J fl b. (Middle)

L.

18a. SIGI'JATUR"i!;-- ··-·---· ..

--c. (L&st)

Daven

13. COLOR

Whf~eRACE

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:-Ci

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Lf

)

R

EN

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PREVIOUSLY BORN TO THIS MOTHER

(Do NOT include this child)

a. How m a n y

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b. How many OTHER

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c. How many diifdren

OTHER children children were born alivo v:ero stillborn (born

aro now living? but are now dead? dead after 20 ~ceks

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pregnancy)? U

.. -... ·-·· ·-· tab-:-ATTiN-DANT

AT

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BfRTu-M.D. ( __ ) D. 0. ( ) Midwife ( ) Other ( ) X (Specify)

ELLA A MEAD, M.D.

--~---·--- 13d. DAfE SIGNEf

910

!Be. 1\DDRESS

Greeley, Colorado

- 20 REGISTRAR'S SIGNA'rtrRR

W. A.

HOTCHKISS

21. DATE ON WHICH GIVEN NAME ADDED

BY

(R~gistrar)

I,

J,

H. WHITE, M.D .. Local Registrar of Vital Statistics for tho County of Weld, State of Colorado, do hereby ccrtiiy that the above is a full, true,

and correct copy of the record of birth of ...

W.ILLIAM

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. F..ABR

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(Name) • /,.

in my custody, and now on file ln my office.

Given under rny hand and seal this ...

24tli..

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day of ... : ...

Feb.r.u

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a.r.y:

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Registration District No. 238, Weld County, Colorado, '· .•. · · ·

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