USA > Massachusetts > Franklin County > Leverett > Deposition - Births 1852-1918 > Part 4
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SECTION 15. Whoever wilfully makes a false return relative to a birth, marriage or death shall forfeit not more than fifty dollars.
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SECTION 28. An oath which is required by the provisions of this chapter may be administered by the clerk or assistant clerk of a city or town.
Commontocalth of Massachusetts.
No. 22.
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
of ...
The undersigned on oath depose and say that the record relating to the birth Rena Josephine Clark in the Town of Leverett.
(Name of child.) (City or town.) (Name of city or town.) does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of faets omitted or incorrectly stated in said record : -
Date of birth, Zug 2.1902
Name of child, Rena Josephunic
Sex, Female
Color, White
Condition (twin, &c.),
Place of birth, .
Leverett
Name of father,
Frank black
Maiden name of mother.
Edith bobb.
Residence of parents,
Leverett
(at time the birth occurred.)
Occupation of father,
Teamster
(at time the birth occurred.)
Birthplace of father,
inToutaque
Birthplace of mother,
new Hampshire
SIGNATURE. Mrs Edith Pryce
RESIDENCE. (City or town, street and number, if any.) 29 Berlin SI-
1
Relation to child, if any. mother
montpellier Denunt July 6. 1923 Date,
Then personally appeared before me the person whose signature appear 3 above and made oath that the statements subscribed to by. Trav
Recorded Belep. , 1923.
are true. Endcontest Janina Notary Public "Ity or town.) Of Toushington County Vermont Mass
Commonwealth of Massachusetts.
No. /.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose &and saye that the record relating to the birth of Mimi & Dodge. fr. (Name of child.) in the ms of Descrett (City or town.) (Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : --
Date of birth, august 24:" 19/7
Name of father,
Mermi &. Dodge
Maiden name of mother,
Residence of parents, Verrett
(at time the birth occurred.)
Occupation of father,
Bx-22zakir
(at time the birth occurred.)
Birthplace of father,
Inch- Livrett
Birthplace of mother,
Cast Lererett
SIGNATURE. mirmir & Dodge
RESIDENCE. (City or town, street and number, if any.)
Leverett
Relation to child, if any. Father
Date, March 9." 1914.
Then personally appeared before me the person whose signature appear-& above and made oath that the statements subscribed to by Kniv are true.
Recorded
march 9" 1914.
Clerk:
("ity or towu.)
Of
Lerutt Mass.
Name of child,
Floris Edna Dodge
Sex, Female
Color,
While-
Condition (twin, &c.),
Place of birth,
Leverett
Commonwealth of Massachusetts.
No. 2
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath deposeQ and say that the record relating to the birth
of Frederick B. Iguais
in the Form of Lerrett
,
(Name of chffd.)
(City or town.)
(Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, February 19" /894.
Name of father,
Elar BEguiris
1
Maiden name of mother Dumil Boynton
Residence of parents,
Serezett
(at time the birth occurred.)
Occupation of father,
JM-maker
(at time the birth occurred.)
Birthplace of father,
Enfield- mace.
Birthplace of mother,
Livrett- hace
SIGNATURE.
Silas 3. ¿ quizie
RESIDENCE.
(City or town, street and number, if any.)
Leverett- brau.
Relation to child, if any. Father
Date, March 24." 1914.
Then personally appeared before me the person whose signature appear & above and made oath that the statements subscribed to by him are true.
Recorded March 24." 1914.
Of
(City of town,y
Livrett
Mass.
Name of child, Frederick B. Ignvice
Sex, ale
Color, White
Condition (twin, &c.),
Place of birth,
Leverett
Commonwealth of Massachusetts.
No.3.
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath deposee and saye that the record relating to the birth
of. Franklin B. Squires
(Her town.) (Name of city or town.) , (Name of child.) in the Inn of Linuett
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of faets omitted or ineorreetly stated in said record : -
Date of birth, January,." 1899
Name of child, Franklin B. queric
Sex, male
Color, While.
Condition (twin, &c.),
· Place of birth,
Nevezett mare.
Name of father, c
Chlae B. Lavice
ther: Fammia Boymbert
Residence of parents,
Vererette Brand.
(at time the birth occurred.)
Occupation of father,
Bx-maker
(at time the birth occurred.)
Birthplace of father,
Enfild - mare .
Birthplace of mother,
Leverett - mall.
SIGNATURE.
Pilar B. Equico
RESIDENCE.
(City or town, street and number, if any.)
Relation to child, if any. Father
Date, march 24: 1914
Then personally appeared before me the person whose signature appear & above and made oath that the statements subseribed to by. are true.
Recorded March 24: 1914.
Of
Serael Jay len. JanClerk.
(City or town.)
Livrett
Mass.
Commonwealth of Massachusetts.
No.
4
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
of
The undersigned on oath depose and say that the record relating to the birth .in the c'hILL of Dererett Forral G. Briggs (Name of child.) (City or town.) (Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth,
anguil 5: 1900
Name of child,
Erwel ty Brace
Sex, ale
Color, White
Condition (twin, &c.),
Place of birth,
Generelt, wasl.
Name of father
Elmur G, Brigge
Maiden name of mother.
Mary & Klager
Residence of parents,
Keresett Back
(at time the birth occurred.)
Occupation of father,
Farmer-
(at time the birth occurred.)
Birthplace of father,
Leverett mare.
Birthplace of mother,
Keresett mace.
SIGNATURE. Elmir C. Brigge Mary &. Briggs
RESIDENCE.
(City or town, street and number, if any.)
Leverett
Relation to child, if any. Hallur mother
Date, Juhl: 10" 1915.
Then personally appeared before me the person & whose signature & appear above and made oath that the statements subscribed to by thetin are true.
Recorded September 18" 19/5
Of
Serael Jaylen. Ennek. (City or town.) Leverett. Mass.
Commonwealth of Massachusetts.
No. 5
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14,)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) The undersigned on oath depose and say that the record relating to the birth Ruth Waterman in the air of Einerett 12 Lack.
(City or town.) (Name of city or town.) of.
(Name of child.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, family 12" 1897
Name of child, C Rith Vaterman
Sex, Finale
Color, White
Condition (twin, &c.),
Place of birth,
Lescritte Mace.
RESIDENCE.
SIGNATURE.
Waterman
Mary a. Malerman
(City or town, street and number, if any.)
Leverett
Verrett
Mall-
Relation to child, if any. Falluí Mother-
Date, May 18:" 1916
Then personally appeared before me the persone whose signature & appear above and made oath that the statements subscribed to by their .are true.
Recorded May 15" 1916.
Serach Tay In Clerk (''ity or town,s/ Lesett Mass.
Of
Name of father,
& Vh Ylateran
Maiden name of mother,
Mary a Jocelyn
Viverett"
Residence of parents,
(at time the birth occurred. )
auner.
Occupation of father,
(at time the birth occurred.)
Birthplace of father,
Philipelro mare
Birthplace of mother,
Commonwealth of Massachusetts.
No. 6.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Gertrude Belle Collia
verezett vlak. , (Name of ehild.) in the
(City or town.) (Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record :- -
Date of birth. January 5." 1899
Name of child, Gertrude Belle Gerile
Sex, Tennale
Color, While-
Condition (twin, &c.), normal
l'lace of birth,
Berrett. Mark.
Name of father,
Maiden name of mother.
Lena ? Perdare
Residence of parents,
Leverett Barase.
(at time the birth occurred.)
Occupation of father,
Br Manufacturing
(at time the birth occurred. )
Birthplace of father,
Birthplace of mother,
New Salen Mare.
SIGNATURE. Mym & Collie
RESIDENCE. (City or town, street and number, if any.)
80 annecy Street
Relation to child, if any.
1 Falluo
Date, France 17." 19/8
Then personally appeared before me the person whose signature appeare above and made
oath that the statements subscribed to by. 122222 are true.
Recorded Anne 18: 1918.
Henry I. Herchouity (City of tary Public Of Springfield Mass.
No. 7
Commonwealth of Massachusetts.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Herbert Charles glazier in the tour of Leverett. (Name of city or town.) (Name of child.) (('ity or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, Oct. 29, 1895
Name of child, . Herbert Charles glazier
Sex, male
Color, Wollte
Occupation of father,
Labour
(at time the birth occurred.)
Birthplace of father,
Livrett.
Condition (twin, &c.),
Place of birth,
Birthplace of mother,
Stamford Ut.
SIGNATURE. Charles W. glazier
RESIDENCE. (City or town, street and number, if any.)
Leverett
Relation to child, if any. Father
Date, nov. 11, 1918
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by me are true.
Recorded nov. 11, 1918
Israel Taylor (City or tywin.)
JourClerk .
Of Leverett Mass.
Name of father, Charles. W. Glazier
Maiden name of mother.
Laura S. Strope
Residence of parents,
Leverett,
(at time tlie birth occurred.)
No. 8
Commonwealth of Classachusetts.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Manca Grumman Burnak in the Dir of Leverett (Name of child.) ((Her town.) (Name of cityror town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorreetly stated in said record : -
Date of birth, Number 21 " 1902
Name of father.
Herbert Thai Buna
Name of child, agne Grumman Burner
Maiden name of mother
Marin Eliga Gardner
Sex, Female
Color.
While
Residence of parents,
Leverett
(at time the birth occurred.)
Occupation of father,
Saber
(at time the birth occurred.)
Birthplace of father,
Horculie-mail
Condition (twin, &c.),
Place of birth,
Lescuett
Birthplace of mother,
Lercut Back.
SIGNATURE.
RESIDENCE.
(City or town, street and number, if any.)
malague- mare.
Relation to child, if any. mother
Date. January 8: 1919
Then personally appeared before me the person whose signatures appear & above and made
oath that the statements subscribed to by
are true.
Thomas & Harringni .Clerk.
(City or town.)
Of Justice of the Peace. Mass.
Recorded January 8: 1919.
No. 9
Commonwealth of Massachusetts.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Persia Belle Black (Name of child.) in the thu2 of Lesrett
(City or town.)
(Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record :-
Date of birth,
October 7: 1346
Name of father,
Frank Ve Gluck
Name of child, Jesu Belie Click 1
Maiden name of mother.
Edith Preplerin Gibt.
Residence of parents,
(at time the birth occurred.)
Occupation of father,
Jeannelet
(at time the birth occurred.)
Birthplace of father,
Millere Falle. Blues.
Birthplace of mother,
Helpoce M. Hampshire
SIGNATURE. Sve South of Royer
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any. Boller
"montpelier Termrent- Date, Celiter 7." 1919
Then personally appeared before me the person whose signature appear & above and made oath that the statements subscribed to by
are true. William h. herault
Recorded Cortar 9- 1919.
(City or town.) Of Notary Public Ferman 18.
Sex, Tervinte 5
Color,
Condition (twin, &c.),
Place of birth,
Serrett mark.
Commonwealth of Massachusetts.
No. 10
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Rachel de relever in the
(Name of child.)
(Name of city-or-town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, march 8" ,"
Name of child, , Pache i la Deckqueny
Sex, Female
Color,
White
Condition (twin, &c.),
Place of birth, .
Leverett . Miau.
Name of father. poreph K. Dickwenn
Maiden name of mother. Frettie Plate
Residence of parents, Leverett
(at time the birth occurred.)
Occupation of father,
221213
(at time the birth occurred.)
Birthplace of father,
Birthplace of mother,
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Verrett
Relation to child, if any. Father
Date, Cerchi 24: 1920
Then personally appeared before me the person whose signature appear e above and made oath that the statements subscribed to by are true.
Recorded
March 27.", 20
avail Taylor
anne Clark
((ity or town.) Leverett Mass.
Of
(CHy-of-town.) Imize of. Sercette Pireus.
Commonwealth of Classachusetts.
No. / /
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Alexander Hi kaliumasin the Town of distrett (Name of child.)
(''ity or town.)
(Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorreetly stated in said record :
Date of birth,
Jan 11, 1918
Name of father,
Cliy Mikalinnas
Name of child, Ellevander, Mikaliumas
Maiden name of mother.
Evaltempie
Residence of parents,
Leverett.
(at time the birth occurred.)
Occupation of father,
Jarmer
(at time the birth occurred.)
Birthplace of father,
Mesia.
Place of birth,
Leverett
Birthplace of mother,
SIGNATURE.
aleksandra
RESIDENCE.
(City or town, street and number, if any.)
Leverett
Relation to child, if any.
mikeuliunas
Date, December 31, 1920.
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by him are true.
Recorded
Dec. 31, 1920
Sarael Taylor
. Clerk.
(City or town.)
Of Liverett,
Mass.
Sex,
male
C'olor,
Ihrite
Condition (twin, &c.),
Commonwealth of Massachusetts.
No. _ / 2
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth ( of Mary vybre tonaut in the house of Verruilt
(City or town.) (Name of city or town.) , (Name of child.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth,
Name of father
Théodore n conant.
Maiden name of mother.
Residence of parents,
une zeil
(at time the birth occurred.)
7
Occupation of father,
(at time the birth occurred.)
Birthplace of father,
Birthplace of mother,
d'iciteil Dass
SIGNATURE. Theodor & 2 konut
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any.
Hadley
Date, Tilay 11- 1721
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by tive are true.
Es Lacl (City or town.)
Clerk.
Recorded Dia4 11, 1921
Of
Leverett Mass.
Name of child, Mary ' 4 bit
Sex, Female
Color,
Condition (twin, &c.),
Place of birth,
neveutt
Commonwealth of Massachusetts.
No.
-13
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
of
The undersigned on oath depose and say that the record relating to the birth Sophie annie Milesky in the Town of herciett (Name of child.) (City or town.) (Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or ineorreetly stated in said record : -
Date of birth, Dec. 25, 1905
Name of child, Soplar Milesky
Sex, Female
Color, White
Condition (twin, &c.), Single
Place of birth,
Livrett.
Name of father.
Frank mileskey
Maiden name of mother. Joczy lowski
Residence of parents,
everett
(at time the birth occurred. )
Occupation of father,
Farmer
(at time the birth occurred.)
Birthplace of father,
Poland
Birthplace of mother,
Poland
SIGNATURE. Sophia annie Melesley
RESIDENCE.
(City or town, street and number, if any.)
Sunderland
Relation to child, if any.
Date, Oct. 15, 1921
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by her are true.
Recorded
Oct. 19. 1921.
Marcel Taylor blek
(its or town.)
Of Leverett. Mass.
No. 14
Commonwealth of Massachusetts.
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of alek mikaliunas in the Town of Leverett
(Name of child.) (City or town.) (Name of city or town.) , does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, aug 21 st, 921
Name of father,
alex nikalunas
Name of child, . Sohn n kalunas Maiden name of mother,
Eva Pennpies
Residence of parents,
Leverett
(at time the birth occurred. )
Occupation of father,
Farmer
(at time the birth occurred.)
Birthplace of father,
Russia
-..
Condition (twin, &c.),
Place of birth,
neverett
Birthplace of mother,
Russia
:
SIGNATURE. лек тикалистка
RESIDENCE. (City or town, street and number, if any.)
2 réserett
Relation to child, if any. Father
Date,
Dec 28 , 921
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by 'Lem are true.
Recorded
Dec 28, 1921
Serael Factor. (("ity or town.)
Clerk
Of Leverett. Mass.
Sex,
L male
Color, Le leite
Commonwealth of Massachusetts.
No.
15
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Myra Stebbins Field in the tour of L'Everett
(Name of child.)
("'Ity or town.)
(Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, Dec. S, , 8 MM
Name of father,
Name of child, ,Myra Stebbins Field
Maiden name of mother.
Ella dangram
Sex, Finale
Residence of parents,
Everett
(at time the birth occurred.)
Color, white
Occupation of father,
carver
(at time the birth occurred.)
Birthplace of father,
N'avezett
Condition (twin, &c.),
Place of birth,
Leverett "i've
Birthplace of mother,
nereutt .
SIGNATURE. Marede & Field
RESIDENCE. (City or town, street and number, if any.)
I heart Mass
Relation to child, if any. Lister
Date, 1722. 2 3, 92 2
Then personally appeared before me the person whose signature appear above and made
oath that the statements subscribed to by reu are true.
Recorded Mar. 23, 1922
Susan I Whitaker The cruel City of town.) musscover
.Clerk. my Commission expin mue 11, 1926 Of intent Mass.
,
No. 16
Commonwealth of Massachusetts.
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Mabel Gertrude Having to the tour (Name of child.) (thirty or town.) of Ferait (Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, Hor. 27 1893
Name of father
John W. Harrington
Name of child, Mabel Gertrude
Sex, female
Color, white
Occupation of father,
Blacksmith
(at time the birth occurred.)
Birthplace of father, FeverEst, n'as.
Condition (twin, &c.),
Place of birth, Lennart, Mast
Birthplace of mother, Enfield, Mass
SIGNATURE. John W. Harrington
RESIDENCE. (City or town, street and number, if any.)
Enfield, Mass
Relation to child, if any. Kather
Date, July 14, 1922
Then personally appeared before me the person, Whose signature
appear
above and made
oath that the statements subscribed to by hum are true. Edwin H. Howe Check. getty or towy Justice of the Peace. Mass.
Recorded July 14, 1922.
Of Enfield.
Maiden name of mother .. Winnie Hanks
Residence of parents, Terreet, Mass. (at time the birth occurred.)
No. 17
Commonwealth of Massachusetts.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap, 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth Florence Etta Harring toin the Town of
{CHy or town.) FeverEtt Mass (Name of city or town.)
does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, March 3 1897
Name of father,
John W. Harrington
Name of ehild, Florence E. Harrington
Sex, female
Color, White
Condition (twin, &c.),.
Place of birth, Turatt, Mass.
Birthplace of mother, Infield, Mass.
SIGNATURE. John W. Harrington
RESIDENCE. (City or town, street and number, if any.)
Enfield, Mass,
Relation to child, if any. Father
Date, July, 14, 1922,
Then personally appeared before me the person ? whose signature
appear above and made
oath that the statements subscribed to by. trim are true.
Recorded July 14 192.
Edwin H. Howe
Clerk
(ist way) of the Peace
infield Mass.
Of
Maiden name of mother. Winnie Hanks
Residence of parents,
Fraatt mass.
(at time the birth occurred.)
Occupation of father,
Blacksmith
(at time the birth occurred.)
Birthplace of father, Finnett, Mass.
of.
(Name of child.)
Commonwealth of Massachusetts.
No. 18
DEPOSITION
CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
The undersigned on oath depose and say that the record relating to the birth of Beth Evelyn Williams in the town of rererett. (Name of child.) (City or town.) (Name of city or town.) does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -
Date of birth, aug 8, 18 98
Name of father, ¿ there Williams
Name of child, Beth Evelynkellums Maiden name of mother.
: Effie tunt
Residence of parents,
Merciett
(at time the birth occurred. )
Occupation of father,
(at time the birth occurred.)
Birthplace of father,
unterland
Condition (twin, &c.),
Place of birth,
nevezett
SIGNATURE, Lina Riwilliams
RESIDENCE. (City or town, street and number, if any.)
44 Cleveland St. I'veregulat massi
Relation to child, if any.
Inter
Date, nov.6. 1922
Then personally appeared before me the person whose signature
appear above and made
oath that the statements subscribed to by . hier are true.
y'enguk. Rockero
Clerk
('ity or town.) notary Publichad
Recorded 7. 00. 10, 1922
Of
Mass.
Sex,
Color, lotule .
Birthplace of mother,
No. 19
Commonwealth of Classachusetts.
DEPOSITION CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)
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