USUAL RESIDENCE OF MOTHER

(WHERE OOU NQTI-IU liVtU

FATHER Of

CHILD

INFORMANT'S CERTIFICATION

ATTENDANT'S CERTIFICATION

REGISTRAR' S CERTIFICATION

\

; COUNTY iOF ALAMEDA

STATE

FILE

OAKLAND, CALIFORNIA _j'

CERTIFICATE OF LIVE BIRTH

_ _ .- \. .

Tri-Valley Office ';(..Qv--t http://www.acgov.org/auditor/clerklbdm/Birth.htm ~nline order

LOCAL REGISTRATION

DISTRICT AND 601~531.8

CERTIFIED COPY OF VITAL RECORD STATE OF CAUFORNIA, COUNTY OF ALAMEDA 1111111111111111111111111111

This Is a true and exact reproduction ol the document olllclally registered and placed on llle In the oft ice olthe Alameda County Clerk-Recorder.

MAR 10 2019

000017032

~IV'k/di.J Melissa Wilk

COUNTY CLERK-RECORDER

This copy lo not volld unloeo proporod aji an engraved border dleplaylng tho date, .. ala~elftoWI•d lllo CIOII•R••••••·

[Reproduced for educational purposes only. Fair Use relied upon.]

Oo 0 \)..~ '-? .• ()'-sTATEMENT rV · OF • ·~ORRECTIONS

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--....9

COUNTY OF ALAMEDA OAKLAND, CALIFORNIA

lN~ORMAMNAL-. NOT A VAUD DOCUMENt TO ~TABUSM 'D!NnTV

:A_AFFIDAVIT TO CORRECT A RECORD

Tri-Valfey Office http://www.acgov.org/auditor/clerklbdmiBirth.htm online order

CERTIFIED COPY OF VITAL RECORD

4. DATE ORIGINAL FILED

November 5 1964

STATE OF OAU..FORNIA, COUNTY OF ALAMEDA

This is a true and exact reproduCtion of the document olllclalfy registered and placed on file in the office of the Alameda County Clerk-Recorder.

1111111111111111111111111111 0 0 0 0 1 7 0 3 1

~IV~di.J DATE ISSUED

MAR "10 2019 ,...

Melissa Wilk COUNTY CLERK-RECORDER

Thio copy Is not valid unlo88 prePftod"" .., ~cijur~d )lotclor dl•playlng lho date, eoal ~n~ -~~~~0 l)ll~o CIO<• ·FI-tdfl

.•

[Reproduced for educational purposes only. Fair Use relied upon.]