USA > Massachusetts > Franklin County > Leverett > Deposition - Births 1852-1918 > Part 5
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(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 Millicent ce leaucun the town of herecett . (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,
May 14, 1922.
Name of father,
Harold wordand
Name of child, Gilbert réelwoodard
Maiden name of mother.
Ethel Beaman
Sex
Residence of parents,
Leverett
Color,
white
Occupation of father,
wood worker
(at time the birth occurred.)
Birthplace of father,
Lirerett
Condition (twin, &c.),
Place of birth,
Sunderland
Birthplace of mother,
Greuett
SIGNATURE.
Harold lor dard
RESIDENCE.
(City or town, street and number, if any.)
Relation to child, if any.
hererett
futter
Date, May 11, 1923
Then personally appeared before me the person. whose signature appear S above and made
oath that the statements subscribed to by
are true.
F. H. Taylor Clerk. (City or town.) Les ciett Mass.
Recorded
May 14, 1923
Of
(at time the birth occurred.)
Commontocalth of Massachusetts.
No. 20
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 myrtle Clear butcher 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, Jace, 7, 1909
Name of father Arthur Dutcher
Name of child, Myrtle Celeora Dutcher
Maiden name of mother. Maila Bi ber
Sex, Formule
Residence of parents,
direcett.
(at time the birth occurred.)
Occupation of father,
7
remuer
(at time the birth occurred.)
Birthplace of father,
Shelburne Falls Mass
Condition (twin, &c.),
Place of birth,
Derecett
Birthplace of mother,
Herecett Mass
SIGNATURE.
Arthur Fuether
RESIDENCE.
(City or town, street and nuumber, if any.)
1
Lirerett
Relation to child, if any. Father.
Date, Sept 26, 1923
Then personally appeared before me the person whose signature appear above and made
oath that the statements subscribed to by.
are true.
F. H. Taylor (City or town.)
Clerk.
Recorded
Left. 26, 1923
Of
Mass.
White.
Color,
Commonwealth of glassachusetts.
No. 21
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 nelson Witherbein 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, Oct. 24. 1907
Name of father,
Edgar N. Wetherbee
Name of child, Herbert n. Wetherbee
Maiden name of mother.
nina Rhodes
Residence of parents,
Leverett
(at time the birth occurred.)
Occupation of father,
Box mfg.
(at time the birth occurred.)
Birthplace of father,
Enfield mais
Birthplace of mother,
Pilhave mais
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Edgar H. Wetherbee no grosvenor Vale
bom
Relation to child, if any. Parent
Date, July 3rd 1923
Then personally appeared before me the person whose signature appear above and made
oath that the statements subscribed to by him are true.
Recorded July 9. 1923.
I yar . Elliott (('ity or town.)
Clerk
Of
Thourpou
Mass. bonne
Sex, male
Color,
avluté
Condition (twin, &c.),
Place of birth,
Leverett
and
Commonwealth of Classachusetts.
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.)
The undersigned on oath depose and say that the record relating to the birth
of. Rena teplimellanthe 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 :
Cing 2, 1902
Date of birth, Rena Josephine
Name of child,
Female
Maiden name of mother, Edith Cobb.
Residence of parents,
Leverett
(at time the birth occurred. )
Occupation of father,
Jaamster
(at time the birth occurred.)
Birthplace of father,
monta que
Birthplace of mother, new Hampshire
SIGNATURE. Mrs Edith Royce
RESIDENCE. (City or town, street and number, if any.)
29 Berlus St.
Relation to child, if any. mother
mouthelise It
Date, July 6, 1923
Then personally appeared before me the person whose signature
appear above and made oath that the statements subscribed to by her are true.
Recorded July 9, 1123
Edward N. Leavitt ((ity or town.) notary Public
Of Washington Lo. Massa Ut.
Sex,
Color, white
Condition (twin, &c.),
Place of birth,
Arerett
Name of father,
Frank black
Commonwealth of Classachusetts.
No.
23
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. Eugene Earl goshea in the town of
+ (Name of child.) (City or town.) Leverett ,
(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 : -
nov. 141909
Date of birth, Jan 17 1924 Name of father, Israel Peter Joshera-
Name of child, Eugene Earl PushedMaiden name of mother.
Pose mitalda. Langlor 2
Sex,
male
Residence of parents. Leverett
(at time the birth occurred.)
Color,
white
Occupation of father, Sectione Boss (at time the birth occurred.)
Birthplace of father, bancada
Condition (twin, &c.),
Place of birth,
Leverett
Birthplace of mother, St. albans Ut.
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any.
528 banal It
Holyoke Mais mother
Date, Jan 17. 1924
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by her . are true.
Recorded Jan 17, 1924
7. Il. Taylor (City or town.)
Clerk.
Of
Lerciett. Mass.
Pose metalda Joshua
Commonwealth of Massachusetts.
No. 24
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 Joseph garbil 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, June 26, 1907
Name of father
Dolce Farbil
Name of child, Joseph garbil
Sex, male
Color, white
Condition (twin, &c.),
Place of birth,
werenett
Birthplace of mother,
Poland Russia
SIGNATURE. John garbil
RESIDENCE. (City or town, street and number, if any.)
So. Deinfuld
man
Relation to child, if any.
Father
Date,
Mar . V. 1924
Then personally appeared before me the person whose signature appear above and made
oath that the statements subscribed to by him are true.
F. J. Jarfler (City or towu.)
Clerk.
Recorded
Mai 10, 1924
Of.
- Mass.
Maiden name of mother. Mary Joadlowska.
Residence of parents, Leverett. (at time the birth occurred.)
Occupation of father,
Farmer
(at time the birth occurred.)
Birthplace of father,
Poland, Russia
Commonwealth of glassachusetts.
No. 25
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 Clarence Rule (Name of child.) in the Town of Laverett (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, May 14, 1912
Name of child, Clarence Rule
Maiden name of mother.
myra boya
Residence of parents,
Lercrett.
(at time the birth occurred. )
Labour
Occupation of father,
(at time the birth occurred.)
Birthplace of father,
Saranac n. y
Birthplace of mother,
Ciltone
n. 4
SIGNATURE.
Fred Rule
RESIDENCE. (City or town, street and number, if any.) )
Relation to child, if any. Father.
Date, may 18, 1926
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by - herze are true.
Recorded July 7. 19.26
Charles 26. Beamau
('ity of town.) notary Public
Karenett Mass.
Of
Name of father,
Fred Rule
Sex, male
Color, White
Condition (twin, &c.),
Place of birth,
Leverett
Commonwealth of Massachusetts.
No. 26
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 monroe Stowell in the Tour 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, February 8, 1922
Name of father, Leon Ballow Stowell
Name of child, Hubbard monve Stower file
n name of mother. Emma marianutting
Sex, male
Residence of parents,
Leverett
(at time the birth occurred.)
Color, White
Occupation of father,
Electriccapuator
(at time the birth occurred.)
Birthplace of father,
herr echt.
....
Condition (twin, &c.),
l'lace of birth,
Laverett
Birthplace of mother,
Stulestuary
SIGNATURE.
RESIDENCE.
(City or town, street and number, if any.)
Emma Maria Stowell Leverett, Mais
Relation to child, if any. mother
Date, Sept. 7. 1927
Then personally appeared before me the person whose signature appear above and made
oath that the statements subscribed to by her are true.
F. J. Taylor
.. Clerk
Recorded Sept. 7, 1927
(""ity or town.)
Leverett Mass.
Of
No. 27
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.)
of.
The undersigned on oath depose and say that the record relating to the birth Julia agnes Brownein the Tour 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, august, 8, 1912
Name of father, Walter Roderick Brown
Name of child, Julia agnes Browne Maiden name of mother Della Marie Brown
Sex, Famale
Residence of parents, Leverett (northe) (at time the birth occurred.)
Color, white
Occupation of father,
Erecting Engineer
(at time the birth occurred.)
Birthplace of father, Conve new Hampshire
Condition (twin, &c.),
Place of birth, Leverett, Mass,
Birthplace of mother, Liverpool England
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any. Della Marie Brown 203 Riverside are
Medford mass
mother.
Date, Sept . 22,1927
Then personally appeared before me the person whose signature appear S above and made oath that the statements subscribed to by her are true.
Recorded Dec. 15, 1927
Fred H. Robinson Crest. (City of town.) Juste ilof the Place F. J. Taylor blesky Lereut, Mas.
Of
Commonwealth of Classachusetts.
No. 28
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 Cephas F. Frary (Name of child.) in the Town of Leverett. (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 ineorreetly stated in said record : -
Date of birth, august 9, 1858
Name of father
Francis Frary
Name of child, Cephas F. Frary
Sex, male
white
Occupation of father,
merchand
Kat time the birth occurred.)
Birthplace of father,
unknown
Condition (twin, &c.),
Place of birth,
Leverett
Birthplace of mother,
Leverett, mass
SIGNATURE. Carrie I. Taylor
RESIDENCE. (City or town, street and number, if any.)
Leverett
Relation to child, if any. Cousin
Date, nov. 12. 1927
Then personally appeared before me the person whose signature appear S above and made
oath that the statements subscribed to by her are true.
F. J. Taylor
.Clerk.
(City or town.)
Recorded nov. 12. 1927
Of .. .
- Lerett
Mass.
Maiden name of mother.
Louisa Hobart
Residence of parents,
Leverett
(at time the birth occurred.)
Color,
Commonwealth of Massachusetts.
No.
29
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 John (Name of child.) in the Town of Lerenett (City or town.) (Name of city or town.) 9 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, november, 27, 1911 Name of father.
Eddie & Conklin
Name of child, anthony bourline
Maiden name of mother.
Posu Polanis
Sex, male
Color, . white
Residence of parents,
Lerenett
(at time the birth occurred.)
Occupation of father,
Fanner
(at time the birth occurred.)
Birthplace of father,
Lithuania
Condition (twin, &c.),
l'laee of birth,
Leverett
Birthplace of mother,
Lithuania
.
SIGNATURE.
Eddie J. Conklin
RESIDENCE.
(City or town, street and number, if any.)
Leverett
Relation to child, if any. Father.
Date, november 29,1927
Then personally appeared before me the person whose signature appear S above and made
oath that the statements subscribed to by hum are true.
F. W. Taylor
.Clerk
(City or town.)
Leverett, Mass.
...
Recorded nov. 30, 1927
Of
Commonwealth of Massachusetts.
No. 30
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 aubert glenwood Williams on the Town of reverett (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, nov. 25, 1906
Name of father. LewisH. Williams
Name of child, albert Glenwood Williamstia.
en name of mother, alice m. Pattruel
Leverett.
(at time the birth occurred.)
Occupation of father, Sawyer
(at time the birth occurred.)
Birthplace of father, Lerrett
Condition (twin, &c.),
Place of birth,
Lwett
Birthplace of mother, Templeton
SIGNATURE.
Lewiss. Williams
RESIDENCE. (City or town, street and number, if any.)
Leverett
Relation to child, if any. Father
Date, June 1, 1929
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by
are true.
Recorded June 1, 1929.
Of
F. W. Taylor. Clerk (('ity or town) Leverett Mass.
Sex, malo
Residence of parents,
Color, white
No. 31
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 ... Blanche g. Waterman the town of (Name of child.)
(City or town.) Leverett (Name of eity 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, nov. 20, 1891
Name of father, George W.Waterman
Name of child, Blauche J. Waterman Maiden name of mother,
Manya Joslyn
Sex, Female
Residence of parents,
(at time the birth oceurred.)
Color,
Occupation of father, warner (at time the birth oeeurred.)
Birthplace of father, Plulipastou
Condition (twin, &c.), -
Place of birth,
Birthplace of mother, new Saleur
SIGNATURE. George W. Waterman
RESIDENCE. (City or town, street and number, if any.)
vertritt
Relation to child, if any. Father
Date, Serne 11, , 929
Then personally appeared before me the person whose signature appear S above and made
oath that the statements subscribed to by
are true.
F . Caylor (City or town.)
Clerk.
Recorded June 11, 1929
Of
Viccrett Mass.
Zulute
Commonwealth of Massachusetts.
No.
32
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 Daisy & Waterman in the tour of Gruerett
(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, april 10, 1982
Name of father George W. Watermine
Name of child, Daisyn Inalerman
Maiden name of mother. mama Joslyn
Residence of parents,
Jiverett
(at time the birth occurred.)
Occupation of father,
Fariner
(at time the birth occurred.)
Birthplace of father,
Philipstore
Place of birth,
Birthplace of mother,
new Salem
SIGNATURE. george w. Waterman
RESIDENCE.
(City or town, street and number, if any.)
L
querett
Relation to child, if any. Father
Date, fre 11, 19 29
Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by .. prin are true.
Recorded Sauce 11, 1929
Jour (City or town.)
.Clerk.
1
Of ._ a vierett Mass.
Sex, Female
Color,
Condition (twin, &c.), -
No. 33
Commonwealth of glassachusetts.
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 Emmons Luther Dudley in the Town of Lavarett (Name of child.) (City or town.) (Name of city or town.)
does not fully and correctly state all the faets relating to said birth, and that the following is a true statement of faets omitted or incorrectly stated in said record : -
Date of birth, June 8, 1858
Name of father, Luther Dudley
Name of child, Emmons Luther Dudley Iniden name of mother,
alsamena black
Residence of parents, Leverett (at time the birth occurred.)
Occupation of father, Jammert Lumberng (at time the birth occurred.)
Birthplace of father,
Leverett
Condition (twin, &c.),
Place of birthı,
Laverett
Birthplace of mother,
montague
SIGNATURE.
Mary Holston
RESIDENCE. (City or town, street and number, if any.)
Orange
Relation to child, if any. Sister
Date, apr. 30, 1930
Then personally appeared before me the person whose'signature appear above and made oath that the statements subscribed to by her are true.
Franklin D. gatte
(City or town.) notary Public
Recorded May 7, 1930
Of
Orange Mass.
Sex,
male
Color,
White
Commonwealth of Massachusetts.
No.
34
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 Harry W. ashley in the tour 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, March, 19, 1879
Name of child, , Harry W. ashley m.
Maiden name of mother,
maria E. Field
Residence of parents,
Leverett
(at time the birth occurred. )
Occupation of father,
Farmer
(at time the birth occurred.)
Birthplace of father,
Lucrett
Birthplace of mother,
Hatfield, Mass
SIGNATURE, Susan E. Field
RESIDENCE. (City or town, street and number, if any.)
Leverett
Relation to child, if any. aunt
Date, July 8, 1931
Then personally appeared before me the person whose signature
appear above and made oath that the statements subscribed to by her are true.
Recorded July 8, 1931.
F. J. Taylor Clerk (''ity or lown.) brunett Mass.
Of
Name of father.
William If. ashley
Sex,
Color, W
Condition (twin, &c.),
l'lace of birth,
Lwertt
Commonwealth of Massachusetts.
No.
35
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 Glava Richardson in the Love of Lavectt
of
(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, may 3 89
Name of child, black Richardson
Sex, Farnale
Color, Euhite
Condition (twin, &c.),
Place of birth,
Neverett
Name of father, Anson Richardson
Maiden name of mother. Ruth Peso.
Residence of parents,
Leverett
(at time the birth occurred.)
Occupation of father,
Numbering
(at time the birth occurred.)
Birthplace of father,
Fitchtrung mass
Birthplace of mother,
Belchertown Ması
SIGNATURE.
ausou Riche andone
RESIDENCE. (City or town, street and number, if any.)
Laverett
Relation to child, if any. Father
Date, June 25, 1934
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by him are true.
F. V. Taylor. (City or town.)
. Clerk.
Recorded June 25, 1934
Laverett Mass.
Of
Commonwealth of Classachusetts.
No.
36
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 Eleanor Battistoni in the Town of Leverett (Name of child.) (City or town.) (Name of city or town.)
does not fully and correetly state all the faets relating to said birth, and that the following is a true statement of faets omitted or ineorreetly stated in said record : -
Date of birth, May 18, 1918
Name of child, Eleanor Battistoni
Sex,
Female
Residence of parents.
Leverett (at time the birth occurred.)
Occupation of father, Farmer (at time the birth occurred.)
Birthplace of father,
Italy
Birthplace of mother,
Italy
SIGNATURE.
angelina Battistoni
RESIDENCE. (City or town, street and number, if any.) aucherst (bushwan)
Relation to child, if any.
mother
Date, July 28, 1934
Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by her are truc.
F. H. Taylor (City or towu.)
Clerk.
Recorded July 28, 1934
Of
Lowerett
Mass.
Name of father Eugene Battistoni
Maiden name of mother angelina Campagnare
Color, White
Condition (twin, &c.),
Place of birth,
Leverett
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 say that the record relating to the birth .in the
of. (Name of city or town.) (Name of child.) (City or town.) of 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 child,
Maiden name of mother.
Sex,
Residence of parents,
(at time the birth occurred.)
Color,
Occupation of father,
(at time the birth occurred.)
Condition (twin, &c.),
Birthplace of father,
Birthplace of mother,
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any.
.
...
Date,
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by are true.
Clerk
(''ity or town.)
Recorded
Of
Mass.
Place of birth,
Name of father,
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 say that the record relating to the birth in the
(Name of city or town.) (Name of child.) (City or town.) of . of .. _
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,
Name of child,
Sex,
Color,
Condition (twin, &c.),
Place of birth,
Name of father,
Maiden name of mother.
Residence of parents,
(at time the birth occurred.) ....
Occupation of father,
(at time the birth occurred.)
Birthplace of father,
Birthplace of mother,
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any.
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