i x wry x Patt SRST PITTS RT RT BENT PENT NE he SACRAMENTO COUNTY STATE mEATH CERTHICATE NUMER 1A, NAME OF CriLO—Pensy . t= “Ss TH, SLE. “single SACRAMENTO, CALIFORNIA CERTIFICATE OF LIVE BIRTH STATE OF CALIFORNIA u Hic. Last EAR 146, HOUR—la4 MOum CLOGE Time} ‘ SA. PLACE OF BIRTH—MAWi OF HOSPITAL ON FACILITY SC, CITY OR TOWN FATHER oF CHILD MOTHER oF Crap PARENT'S CERTIFL CATION JA. MAME OF MOTHER FIRST STATED IMFOWMATION ANG THAT IT IS THUE AND CORRECT TO TH BEST OF acy KNOWLEDGE | CERTIFY THAT | ATTENDED Tes sin’ AND THAT THE CHILO WAS BORN ALIVE A ATTEND. | Sop NOUR DATE AMD PLACE STATED ANTS CERTIFL. 1 CERTIEY THAT | HAW REVIEWED TOE |i aii aa ei eae eB ee ie BF AEE IT ATT TY 1290, TYPED WN, | 7 a 18C. LAST (purty MAME) rT SG. RELATIONS TO CHL a thom TSU UCENSE remote ' ' SE AND ADORESS ee aa. N2C. OAze santo ' 113C. DATE mone: ' on Wm. Miller, M.D. - #1 Scripps Drive, Sacto. CA AL 1B, OEATH—46TOR OATH OF DEATH }} REGISTRAR Fa ns Oe A Ee oenels = os -_ —_ CERTIFIED COPY OF VITAL RECORD STATE OF CALIFORNIA, COUNTY OF SACRAMENTO MEX U *9002006354* This ts a true and exact reproduction of the document officially registere and placed on file in the office of the Sacramento County Clerk/Recorder. OCT 06 2021 DATE ISSUED: ss \ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE, \ ™ —] um, 3 AN “See Ayn FR PINS RE OP. ee ram ea AD, eae EFTA00088946 oe