31 Martin Paul Tonsing Birth A

STATE OF KANSAS. 2 0 3 1 3 1 0

PLAGE OF BIRTH.

County of .ycw^.O?*...

STATE BOARD OF HEALTH—DIVISION OF Vrr.u, STATISTICS.

Township of.

STANDARD CERTIFICATE OF BIRTH. .ci.LttLCJ*

City of VAAM>JJfc.£*x Nc^lcS".. Full Name of C h i 1 d . . ^ Z ^ L ^ L i * ^ . . . . Sex Of child,

It rMJd i« not rat M n n l , mafca R-ipplainania.] raport. ma dtractad.

Number in order of birth.

Twin. triplet, or other?

^ r?,,

Legitimate,

"—7~I

•"

rFull un

T f^-T ; F A AJJ3JJD..

^7

Residence. Color.
Ace at last // *7 birthday..ZT..:

Birthplace.

.

. _Jl2 (Month')

".'..."ST.. (Vaarn.)

Birthplace. CLLC*~>~<^. Occupation.

Occupations^

fjTfsshn.

2

NumS*r of rhlWran horn to thia mother, fnrludlnc praaaru Mrth.

^C-SJ

U;

W•^~c~-.

W

KUTTIIMJT of "hlMrfn. of thU mother BOW IWine.

C E R T I F I C A T E OF ATTENDING PHYSICIAN OR MIDWIFE.* I hereby certify that I attended the birth of this child, who was on the date above stated. • V.'h*n th<*r«r * M no ftCtmtfiaf phy*i«-ian or mMw-i!V. *hrn th* '»th*r, homMholraar, Btc. nhouia makf thU return. A •tUIborn child is onr that neither brewtWi nor •s©'** other mw{denre of Iif* fttMT birth.

u

191...

M- rt'

f Bora «.'..•-- o

(Signature) ...

'"tPhyilaUn or t&tCS&OZS

Given name addod from su, plemental report ...

(Voai)

# / '?.

birthday

> ( A^&

UA^JB

f i * j [

191J1. (Day)

Ajre a t last

Color.

(Tear..)

^

birth MOTHER. MVLUEtli.

_ _

Maid N'am< Residence.

Nam<

j Date of

(U ft>5

(To ba arnwarad on\y tn arant of plqral bireha.j

Full

street. Reg. ~So...S...^l..L

Address Filed..

LT.^vn?

_Z__

>3f M.,

NOV - 7 1996 KOI UAUD IF COPitU tHiSIS A COW Of TMF OBlSiMAL aesnFKSlUB dWTIFlEO IMIS ll»Ti • • T O P f M

fficc • VITAL

JTATISTIGS STATIST!

" -"n-

K*N3*S.

^*«-*, CTAtc

ffiOtsTfun

OF HEALTH AKO ENVIHO\'*