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    Birth Certificate San Francisco1

    Uploaded by

    DeyaricDesireeFumeroVillegas
    This document is a certificate of live birth from the City and County of San Francisco, California. It provides identifying information about the child such as name, sex, date and place of birth. It also includes identifying information about the parents such as their names, dates of birth, and states of birth. The certificate is signed by an attendant who certified that the child was born alive at the stated date, time and place of birth.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Birth Certificate San Francisco1

    Uploaded by

    DeyaricDesireeFumeroVillegas
    735 views1 page
    This document is a certificate of live birth from the City and County of San Francisco, California. It provides identifying information about the child such as name, sex, date and place of birth. It also includes identifying information about the parents such as their names, dates of birth, and states of birth. The certificate is signed by an attendant who certified that the child was born alive at the stated date, time and place of birth.

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    © © All Rights Reserved

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    This document is a certificate of live birth from the City and County of San Francisco, California. It provides identifying information about the child such as name, sex, date and place of birth. It also includes identifying information about the parents such as their names, dates of birth, and states of birth. The certificate is signed by an attendant who certified that the child was born alive at the stated date, time and place of birth.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    735 views1 page

    Birth Certificate San Francisco1

    Uploaded by

    DeyaricDesireeFumeroVillegas
    This document is a certificate of live birth from the City and County of San Francisco, California. It provides identifying information about the child such as name, sex, date and place of birth. It also includes identifying information about the parents such as their names, dates of birth, and states of birth. The certificate is signed by an attendant who certified that the child was born alive at the stated date, time and place of birth.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
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    CITY AND COUNTY OF

    SAN FRANCISCO

    CERTIFICATE OF LIVE BIRTH


    _____________________________ STATE OF CALIFORNIA
    STATE FILE NUMBER USE BLACK INK ONLY LOCAL REGESTRATION DISTRICT AND CERTIFICATE NUMBER
    1A. NAME OF CHILD — FIRST (GIVEN) 1B. MIDDLE 1C. LAST (FAMILY)

    THIS
    CHILD 2. SEX 3A. THIS BIRTH, SINGLE, TWIN, ETC. 3B. IF MULTIPLE, THIS CHILD 1ST, 2ND, ETC. 4A. DATE OF BIRTH—MM/DD/YYYY 4B. HOUR—(24 HOUR CLOCK TIME)

    --
    5A. PLACE OF BIRTH — NAME OF HOSPITAL OR FACILITY 5B. STREET ADDRESS — STREET, NUMBER, OR LOCFATION

    PLACE
    OF 5D. COUNTY 5E. PLANNED PLACE OF BIRTH
    5C. CITY
    BIRTH

    6A. NAME OF FATHER — FIRST (GIVEN) 6B. MIDDLE 6C. LAST (FAMILY) 7. STATE OF BIRTH 8. DATE OF BIRTH
    FATHER
    OF
    CHILD
    9A. NAME OF MOTHER — FIRST (GIVEN) 9B. MIDDLE 9C. LAST (MADEN) 10. STATE OF BIRTH 11. DATE OF BIRTH
    MOTHER
    OF
    CHILD
    I CERTIFY THAT I HAVE REVIEWED THE STATED 12A. PARENT OR OTHER INFORMANT — SIGNATURE 12B. RELATIONSHIP TO CHILD 12C. DATE SIGNED
    INFORMANT
    CERTIFICATION INFORMATION AND THAT IT IS TRUE AND CORRECT
    TO THE BEST OF MY KNOWLEDGE

    I CERTIFY THAT THE CHILD WAS BORN ALIVE AT THE 13A. ATTENDANT OR CERTIFIER — SIGNATURE — DEGREE OR TITLE 13B. LICENSE NUMBER 13C. DATE SIGNED
    CERTIFICATION DATE, HOUR AND PLACE STATED.
    OF Signature RESIDENT
    BIRTH 13D. TYPED NAME, TITLE AND MAILING ADDRESS OF ATTENDANT 14. TYPED NAME AND TITLE OF CERTIFIER IF OTHER THAN ATTENDANT

    15A. DATE OF DEATH 15B. STATE FILE NO. 16. LOCAL REGISTRAR -- SIGNATURE 17. DATE ACCEPTED FOR REGISTRATION
    LOCAL
    REGISTRAR (STATE USE ONLY)

    STATE OF CALIFOFRNIA, CITY AND COUNTY OF SAN FRANCISCO


    This is to certify that the image reproduced hereupon is a true
    copy of the record on file in the SAN FRANCISCO DEPARTMENT
    OF PUBLIC HEALTH as of the date issued. Mitchell Katz, M.D.
    DATE ISSUED Health Officer and local Registrar

    This copy is not valid unless prepared with a border, displaying the date, seal and signature of the City and County Health Officer.

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