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Form 4A H.D.C

         TO BE RETAINED BY PARENTS

     HEALTH DEPARTMENT OF THE DISTRICT OF 
                   COLUMBIA
                      BH
                 ____________

      Certificate of Birth Registration 
                 ____________

This is to Certify, That in accordance with an Act to provide for the better registration of births in the District of Columbia and for others purposes, approved March 1, 1907 the birth of a female child to Sidney F and Doris Blake on July 5, 1928 has been officially registered in the Health Office of the district of Columbia, by Ed. Edgar Snowden

Record No 313,260 Name of Child  

NC Fowler
M.D.,
Health Officer.

To Mrs. Sidney Blake
Columbia Hospital, City.