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For Government Use Only
District
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This is to certify that this is a pug. and correct copy of the original Certificate of Birth on file in the
Office of the Registrar', ThitittNorth Hempstead, County of Nassau, State of New York.
Signature :
Date
No.
VS Form TNH SR 7
/2000 MS tc/rvs
.Registrar of Vail StatisticS
OCT 0 5 2021
N.B. Do not accept this copy unless the raised seal of Me Town of North Hempstead is thereon affixed.
EFTA00257873
tfie Commonweaft6 of 210assac6usetts R
Commonwealth of Massachusetts
Registry of Vital Records and Statistic
RECORD OF BIRTH
111111 ii 110
NAME:
SEX:
FEMALE
PLURALITY:
-SINGLE
DATE OF BIRTH:
. TIME
PLACE OF BIRTH:
NAME:
BIRTHPLACE:
-.
PARENT
NAME:
-
BIRTHPLACE:
AGE OR DATE OF BIM: •
-
DATE OF RECORD:
ATHOL, MASSACHUS Eris
DATE ISSUED:
JULY 27,2021
Registrar of
nod Statistics
1, the above signed, hereby certify that I am the Registrar of Vital Records and Statistics;
that as such I have custody of the records of birth, marriage, and death required by law to
be kept in my office; and I do hereby certify that the above is a true copy from said records.
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-STATE OF CALIFORNIA
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This is a true and exact reproduction of the document officially registered
and placed on Ida in the office of the Sacramento County Clerk/Recorder.
DATE ISSUED:
0CT 0 6 2021
TIL/ copy IL tog
only propel*" on an gr.o/wef Lmler EtEplarj, ihe ONE. EPP! Wa orelf • & the Gmegyflegt/ReCteddr
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EFTA00257876
Registry of Vital Records and Statistics
150 Mount Vernon Street
Dorchester, MA 02125
Order Number: 89435
Total Amount: 50
Order Source: mail
Receipt Date: August 03, 2021
NEW YORK, NY 10007
ORDER SUMMARY
Requested:
Service Type
Copies Certificate Holder(s)
Provided:
Service Type
Birth Certificate Certified Copy- No Fee
Copies
1
If you have any questions about how to make a correction to a certificate, please visit our
website at www.mass.gov/dph/rvrs for more details.
EFTA00257877
FD-340c(4-1,1-03)
File Number
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Serial of Originating D
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\
Date Received
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By
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Yes
No
Receipt Given 0
Yes
No
Grand Jury Material - Disseminate Ordy Pursuant to Rule 6 (e)
Federal Rules of Criminal Procedure
0
yes
N°
Federallimpayerinformadon (FTI)
0
yes
N°
Tdle:
Reference:
(ComanmicationEnclosingMateriab
Description:
0
Orildnal notes re ioterdew of
EFTA00257878
GOVERNMENT
EXHIBIT
FILED
VS100
M. I/18
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(Do not accept if reproduced, or if seal impntssico cannot be let)
THE REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY LAW 04C.193245,193.255. & 193-315. RSMO 2004.)
Ma
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I HEREBY CERTIFY that this Is an exact reproduction of the certificate for the person named
the
as It now appears in the permanent records of the Bureau of Vital Records of the
ailment of Health and
Senior Services. Witneco my hand as State Registrar of Vital Records and the Seal of the
opartment of Health and
Senior Services this date of
JUL 14 2021
IAD 530-1241 (2-2020)
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