OF AN ENTRY

OF AN ENTRY Entry I No, &Waist/Alva yea Application Numbe CERTIFIED COPY NHS Number r.gistration district Sub•dhalot BIRTH 1. Dote and place of birth CHILD 2. Name and surname 4. Nemo and Rumania - - - _ b. Place of birth 8. Occupation 7. Name and surname NIB ER 8. Place of birth 9.(o) Malden ammo 10. thug addross (if different from place of chjd's birth 3, Sox %coy outman° or mcroorpa if difroront from maiden surname I 11. Name and surname (if not the mythic cr father) 12. Oualificetion 13. Usual oddros: (if different from that in 10 above) 14_ ! certify int the pathc 15. t..ato *tart-Ey • ars entered ohnvit At n nun to the best of my ....triodes and belief oiler registrahOn, In-! surname Signature of informant ' lb. Signature of registrar GOVERNMENT EXHIBIT 16 52 2C Cr 330 (ANN) CERTIFIED to be a true copy of an entry in the certified copy of* a register of Births, Still-birth' or Deaths in the District above mentioned. Given at the