EFTA00257888

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ke TATE OF RHODE ISLAND RHODE ISLAND DEPARTMENT OF HEALTH CERTIFICATE OF LIVE BIRTH STATE FILE NUMBER a N DATE OF BIRTH TIME OF BIRTH sx / i 8:13AM FEMALE 2 PLACE OF BIRTH \ = i OF BIRTH CERTIFIER'S NAME/TITLE _ ATTENDANT'S NAMEJTITLE Oe a Te RL Oe i ; MOTHER'S DATE OF tidal AGE t P * FATHER'S DATE OF §IRTH FATHER'S AGE rege ee ee ee eee ee: GOVERNMENT EXHIBIT 12 | hereby certify that this is a'true and exact copy of the document officially rdgistered and placed on file in the issuing office. : 2 3 2 4 3 5 1 Issuing STATE OFFICE, PROVIDENCE Date of Office Issuance : & Signature of Registrar . ZZ THIS COPY VALID ONLY IF ISSUED ON WATERMARKED PAPER CONTAINING SECURITY FIBERS, DISPLAYING SEAL AND SIGNATURE OF STATE OR LOCAL REGISTRAR H i EFTA00257889