Birth Certificate

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Birth Certificate
STATE OF VERMONT
WASHINGTON COUNTY ss. }
Marshfield Town Clerk's Office ............................... , .........
I
................................................................................... Town Clerk of said Town of Marshfield do
Certify
that the records of births in said town now in my custody as Town Clerk show the record of
the following birth:
Name of Child ............................................................................................................
Date of Birth ..............................................................................................................
Name of Father...........................................................................................................
Place of Birth of Father ..............................................................................................
Age of Father .............................................................................................................
Occupation of Father ..................................................................................................
Name of Mother .........................................................................................................
Place of Birth of Mother ............................................................................................
Age of Mother ............................................................................................................
Name of Medical Attendant .......................................................................................
Sex of Child ...............................................................................................................
I hereby certify that the foregoing is a true copy of the record of the birth of
as appears in book ................., page ................... of the birth records of this office.
________________________________________________________________ Town Clerk

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