Application Number12248191-1

Application Number12248191-1 CERTIFIED COPY OF AN ENTRY QBDAC 397343 NHS BIRTH I Ent" 225 Rumba/ Fil t V (4 'a' . :a. Z: I is '' Adaniseallve Mee P..644stralion district 'Um atp-o..O Sub•dwakt en ... a c%-r-I,Q.Q0 1rlf., \ -4 1. Data and plate of birth a Sex 2. Nemo and sumamo .. ti. S • am% tgems-ois.O A etra G — ->r 0,-04- 61 . 4. Name and macaws FATHER • c• ictert • ___ . b. Piece al WM 0. Occupation ...) 7. Name and sumame MOTHER C.1 ,3-.4 ‘....,. a C.N• to " r a. Place of FA.` a(o) Moldon Demons, 1 • ) Surname at manage If differs:et from amt. s_ rzi maiden surname 10. U.ual address III different horn piste of child's birth ‘ 5 ' ' IL Name and sumame LII not the musher w IMMO 12. ClualifkoSon JIM m rt—ces • U. Usual eddroc (rf dillwont from that In 10 above) ... __ la I coif y IFS Me psmeol ars emceed above am heft to the lieu of my ••••••MORM end REA Sionaturc K4-.6.6 w9„•• of infoiment 15. LultO of maisoauon lu. Signature ol MOAN/ '' .C . NON ( 1 - 0 a' A ,- 17. Name Wyse otos moistiv.on. 6 .... • ....am. CERTIFIED to be a true copy of an entry in the certified copy of a register of Births, Still-births or Deaths in the District above mentioned. Given at the GENERAL. REGISTER OFFICE, under the Seal of the said Office on 15th October 2021 'If ibc Centhcale satins, from tneonsinal Retiree. ibe words 'we mewled copy or an amok Out. CAUTION: THERE ARE OFFENCES RELATING TO FALSIFYING OR AIXERING A CERTIFICATE AND USING OR POSSESSING A FALSE CERTIFICATE. 0 CROWN COPYRIGHT WARNING: A CERTIFICATE IS NOT EVIDENCE OF IDENTITY. 2O‘0117 APSFAIS? CTO SDNY_GM_02766968 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00253776 EFTA01335795