| STATE FILE NUMBER |
CERTIFICATE OF LIVE BIRTH
COUNTY OF MARKET DRAYTON
|
1-1765-13 480384
LOCAL REGISTRATION
|
| THIS CHILD |
1A. NAME OF CHILD — FIRST
EDWARD
|
1B. MIDDLE
BOLTON
|
1C. LAST
CLIVE
|
|
2. SEX
MALE
|
3A. THIS BIRTH — SINGLE, TWIN, ETC
GOBLIN
|
3B. ?? ???? ?????? ???? ?? ????????
—
|
4A. DATE OF BIRTH — MM/DD/YYYY
10/15/1765
|
4B. HOUR — (24 HOUR CLOCK TIME)
1617
|
| PLACE OF BIRTH |
5A. PLACE OF BIRTH — NAME OF FACILITY
???????? ?? ??????? ???? ????
|
5B. STREET ADDRESS
???? ??????? ???? ???? ??????????
|
|
5C. CITY
MARKET DRAYTON
|
5D. COUNTY
SHROPSHIRE
|
5E. PLACE OF BIRTH
HOSPITAL
|
| FATHER OF CHILD |
6A. NAME OF FATHER — FIRST
GEORGE
|
6B. LAST
CLIVE
|
7. COUNTY OF BIRTH
SHROPSHIRE
|
| MOTHER OF CHILD |
8A. NAME OF FATHER — FIRST
SIDNEY
|
8B. LAST
BOLTON
|
9. COUNTY OF BIRTH
HEREFORDSHIRE
|