USA > Massachusetts > Middlesex County > Chelmsford > Deposition : births 1897-1918 > Part 2
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(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. 16, 1896
Name of child Josephine margaret Higgins
Sex, Female
Color, White
Oceupation of father,
Labour
(at time the birth occurred.)
Birthplace of father,
Chelford
Birthplace of mother,
Ireland
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
Relation to child, if any.
David Higgins
Chelmsford
Father
Date, afinal 6, 1914
Then personally appeared before me the person whose/signature appears above and made oath that the statements subscribed to by Jun are true.
Odward . Bobbing (City or Lower.)
Clerk
Recorded
Of
Mass.
Condition (twin, &c.),
Place of birth,
Chelmsford
Name of father,
David Higginie
Maiden name of mother.
Delia norton
Residence of parents,
(at time the birth occurred.)
Commonwealth of Massachusetts.
No.
19
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 ou oath depose and say that the record relating to the birth of Le andler Orville Halen Robinson in the Town of Thelinsport
(Name of child.) (C'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, July 14, 1913
Name of child, Grander Hatton Robinson
Sex, Inale
Color, Visite
Condition (twin, &c.),
Place of birth, W. Chelinford mass
Maiden name of mother.
Berth Gertrude Hotten
Residence of parents,
Www. Chelmoje of
(at time the birth occurred.)
Occupation of father,
Shipper
(at tine the birth occurred.)
Birthplace of father,
no. Chelmsford
Birthplace of mother,
Relation to child, if any. Father
Date, fame 12, 1914
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by him are true.
Recorded
Edward Retoury
Clerk.
(City or town.)
i Chequeford Mass.
SIGNATURE.
RESIDENCE. (City or town, street and number, if any.)
700 Cheimen.
Name of father,
Percy Thomas Robinson
No.
DEPOSITION
CONCERNING THE BIRTH
OF
Filed
189 .
Acts of 1897, Chapter 444, Sections 14, 15 and 30.
SECTION 14. Whenever the record relating to a birth, marriage or death in the records of any city or town does not contain all the facts required for record, or when it is alleged that the facts are not correctly stated in such record, the clerk of such city or town shall receive a deposition under oath, made by one who was required by law to furnish the information for the original record, or, at his diserction, by three or more credible persons having knowledge of the case, containing such facts as are desired for record. Having received such deposition he shall then file the same, and record said facts in a separate book to be kept for recording such depositions, adding thereto the name and residence of the deponent and the date of such record, and shall thereupon draw a line through the incorrect statements without crasing them, and enter upon the original record the facts needed to amend the record, and forthwith, if a copy of the record has been sent to the secretary of the Commonwealth, forward a certified copy of the corrected record to the secretary upon blanks provided by him for the purpose, who shall thereupon amend the record in his office, and state in the margin thercof his authority for so doing. Reference to the record of the deposition recorded shall be made by the clerk against the original record. The clerk when furnishing a copy of such record shall certify to the facts contained in the record as amended, and shall state in addition that the cer- tificate is issued in accordance with the provisions of this act, and a copy of this scetion shall be printed on every such certificate. Such deposition, or a certified copy of the record of any other city or town, or of the record made at the time by any person since deceased who was required by law to furnish the evidence of a birth, marriage or death may, at the discretion of the clerk, be made the basis for the record of a birth, marriage or death not previously recorded, and such copy of record may also be made the basis for completing the record of a birth, marriage or death which does not contain all the required facts.
SECTION 15. Any person who wilfully makes a false return in regard to any birth or death shall forfeit not exceeding fifty dollars.
SECTION 30. Any of the oaths required by any of the provisions of this act may be administered by the clerk or assistant clerk of any city or town in his official capacity.
No.
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 deposed and says that the record relating to the birth of Benjamin B. Loring in the Town of Chelmsford
(City or town.)
(Name of gity 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, march 20, 1871
Name of father,
John H. Loring
Name of child, alfred Orlando Lindsey Loving
Maiden name of mother,
Sarah J. Hunt
Sex, male
Residence of parents,
Chelmsford
(at time the birth occurred. )
Color,
gt hite
Occupation of father,
farmer
(at time the birth occurred.)
Birthplace of father,
yarmouth maine
Place of birth,
Chelmsford man.
Birthplace of mother,
Charlestown Mass
SIGNATURE.
Sarah &. Loving Concord Mbals
(City or town, street and number, if any.)
RESIDENCE.
Relation to child, if any.
Mother.
69 Barrett's More Road.
Date, June 17, 1914
Then personally appeared before me the person (whose signature appear above and made oath that the statements subscribed to by her are true.
Recorded
Franklin E, Emero
(City or town.)
of Justice of The Peace
Mass.
Condition (twin, &c.),
Commonwealth of Classachusetts.
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.)
The undersigned on oath deposes and says that the record relating to the birth
in the Couvre of Chelmsford
(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 20, 1871
Name of child, ( ... Alfred Orlando mindrey 0ung Maiden name of mother
Sarah l. Hunt
Residence of parents,
(at time the birth occurred.)
Occupation of father,
barrier
(at time the birth occurred.)
Birthplace of father, Tammonth Marine
Condition (twin, &c.),
Place of birth,
Chetom ford mars.
Birthplace of mother,
her: Charlestown brass
SIGNATURE. Lunch &. Loving
RESIDENCE.
(City or town, street and number, If any.)
Relation to child, if any. Tarather
Concord mar
69 Barrette Mill Road
Date, Same 17, 1914
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by
are true.
Franklin B. Comany
.Glerk.
(City or town.)
Recorded
2014
as thetree of the Place
Mass.
L
Sex, ,
Color, 2) nite
Name of father
58
Commonlocalth of Classachusetts.
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 Ernest Hoemer Blood in the Town of Chelmsford (Name of child.)
(City or town.)
(Name of city of 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 25, 1879
Name of father,
George Horner Blood
Name of child,
Ernest Hosmer Blood
Maiden name of mother. ra
Grace & Harrin.
matori
Residence of parents, ..
Chelmsford
(at time the birth becurred.)
Carpenter
Oeeupation of father,
(at time the birth occurred.)
Birthplace of father,
Chelmsford
Birthplace of mother,
Lowill
SIGNATURE.
Celift
RESIDENCE.
(City or town, street and number, if any.)
Cliftonidade marzo.
Relation to child, if any. Father
Date, October 4 1915
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by him are truc.
Recorded
October 11
1913
Edward & Robbins
Clerk
(''ity or town.)
Of Chelmsford Mass.
Se nale
Color,
White
Condition (twin, &e.),.
Place of birth,
Chelmsford
63
Commonwealth 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.)
The undersigned on oath depose and say that the record relating to the birth of Timothy f. Harrington
(City or town.) (Name of city or/town.) r (Name of child.) in the John 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,
September 22, 1897
Name of child, Timothy . Harrington J
Sex, make
Residence of parents, ..
Chelmsford
(at time the birthy occurred.)
Color,
White
Occupation of father,
Labores
(at time the birth occurred.)
Birthplace of father,
Ireland
Birthplace of mother,
Ireland
SIGNATURE.
Vimostry Harrington
RESIDENCE. (City or town, street and number, if any.)
Chainedand
Relation to child, if any. Father
Date, November 6, 1915
Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by him are true.
Edward & Rotting
(^Ity or town.)
Clerk
Recorded
72.00. 6. 1915
Of
Mass.
Condition (twin, &c.),
Place of birth,
Chelmsford
Name of father,
Timothy Harrington
Maiden name of mother,
Gathering Multen
€
Commonwealth of Massachusetts.
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 Gladys Pearl Henderson in the Town of Chelmsford (Name of childl.)
(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, July 24, 1898
Name of father, Josiah & Henderson
Name of child, Gladys Pearl Henderson
Sex, Female
Color, It hite
Maiden name of mother.
Hannah B. Juntar
Residence of parents,
Chelmsford
(at time the birth occurred.)
Occupation of father,
Lumber yard labour
(at time the birth occurred.)
Birthplace of father, Linnens maine
Birthplace of mother.
Canada
SIGNATURE,
RESIDENCE.
(City or town, street and number, if any.)
Relation to child, if any. Father
Date, -4. 13 1915
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by. hum are true. Edward Rotting (City or town.)
. Clerk.
Of Chelmsford Mass.
Condition (twin, &c.),
Place of birth,
Chelmsford
Javiok & Henderson 85 3. St. Lowill Mare
Recorded .
nov. 13, 1915
23
Commonwealth of Classachusetts.
No.
211
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 Benne DE Carteret
(Name of city or town.) + (Name of child.) in the
does not fully and correctly state all the facts relating to said birth, and that the following is a truc statement of facts omitted or incorrectly stated in said record : -
Date of birth, July 20, 1900
Name of child,
Bessie De Cartent
Sex, Female
Residence of parents,
no chelmsford
(at time the birth occurred.)
Occupation of father,
Stone-cutter
(at time the birth occurred.)
Birthplace of father,
2. Checknoford
Condition (twin, &c.),
Place of birth,
no. Chelmsford
Birthplace of mother,
England
SIGNATURE.
RESIDENCE.
(City or town, street and number, if any.)
Relation to child, if any.
Ellen J. (Carre) De Carteret
Date,
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by are true.
Clerk.
(City or town.)
Mass.
Recorded
Jan 31 19
Of
(City or town.) .. of
Name of father
Halter
DE Carteret
Maiden name of mother.
Ellen? Carré
Color,
Commonwealth of Massachusetts.
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 Marietta Mcnulty
in the forest of
(City or town.) (Name of city or town.) P (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, Sept. 21 1965
Name of child, marietta Im nulty
Sex. Firmale
Residence of parents,
Ca. Checkinjord
(at time the birth occurred. )
Color,
- il nite
Occupation of father,
hammer
(at time the birth occurred.)
Birthplace of father,
theleland
Condition (twin, &c.) , ...
Place of birth,
E. Chefmerid
Birthplace of mother,
Forall mais
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 appears above and made oath that the statements subscribed to by him are true.
Clerk
(('Ity or town.)
Mass.
Of
Recorded Jan. 31, 1916
Name of father,
George a mcnally
Maiden name of mother.
Ella Monika
81
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 George a. Mcnulty in the Town of (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 faets omitted or incorrectly stated in said record :
Date of birth, Scht. 14, 1911
Name of child, .. George a mi multy.
Sex male
Residence of parents,
Ea. Chelmsford
(at time the birth ocgurred. )
Occupation of father,
farmer
(at time the birth occurred.)
Birthplace of father,
thelma and
Condition (twin, &c.) , ...
Place of birth,
Ca Chelmind
Birthplace of mother,
Lowall mais
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
Recorded Jan 31 1 916
(City or town. )
Mass.
Of
Name of 'father,
George a, In nuity
Maiden name of mother,
Ella Roarke
Color,
Arhite
1
122
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 Dorothy Edith Hoegel in the Coun of Cheleford
(Name of child.)
(City or town.)
(Name of city of 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, July 2, 1915
Name of child, Dorothy Earth Hoelgel
Sex, Ferriale
Color,
White
Condition (twin, &c.),
Place of birth,
Chelmsford
Name of father,
Charles F. Noelgel
Maiden name of mother,
Edith In Ruchwrath
Residence of parents,
Chelinda
(at time the birth occurred.)
Occupation of father,
Tool Roiter
(at time the birth occurred.)
Birthplace of father,
methuen mar!
Birthplace of mother,
Bomall Man
SIGNATURE. Char A. Hocles.
RESIDENCE.
(City or town, street and number, if any.)
ho. Chernof.d
Relation to child, if any.
Date, 1.3. 7, 1916
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by are true.
Edward SKotting (City or town.) Chelmsford Mass. Of
. Clerk.
Recorded
Commontucalth of Etlassachusetts.
17
121
7. ..
Commonwealth of Massachusetts.
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.)
The undersigned on oath depose and say that the record relating to the birth of George Gilbert Undre in the .of Thelmafood (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, Oct. 21, 1915
Name of child, George Gilbert Pardoe
Sex, male
Color, White
Condition (twin, &c.),
Place of birth,
East. Chelmsford
Maiden name of mother Rosina Ogden
Residence of parents,
Car
Evet Chelmsford
(at time the birth occurred.)
Dron moulder
Oeeupation of father,
(at time the birth occurred.)
Birthplace of father,
Halifax England
Birthplace of mother,
-1-4
SIGNATURE.
RESIDENCE.
(City or town, street and number, if any.)
Eust Chelmsford
Relation to child, if any. Father
Date, Feb. , 1916
Then personally appeared before me the person whose signature
appear above and made oath that the statements subscribed to by are true.
Edward Robbing
Clerk.
Of
(City or town.) Chelefond Mass.
Recorded
Habe 7, 1916
Name of father
George
& Pardos
68
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.)
of ...
The undersigned on oath depose and say that the record relating to the birth Margaret dr. Donohue in the
(Name of child.) (City or town.) of (Name of clty 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, San. 28 1400
Name of child, Margaret At. Donohue
Maiden name of mother.
Mary Egan
Residence of parents,
(at time the birth occurred.)
Occupation of father,
RR Flag man
(at time the birth occurred.)
Birthplace of father,
Incland
Condition (twin, &c.),
Place of birth,
Chelmsford
Birthplace of mother,
Lucland
SIGNATURE.
RESIDENCE.
(City or town, street and number, if any.)
Chelmsford
Relation to child, if any. - Father
Date, Lib. 16, 1916
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by
are true. Edward Buffing
("ity or town.)
Clerk.
Recorded
Feb. 17, 9/6
Of
Mass.
Sex, temale -
Color, White
Name of father,
Philip Donohue
7
Commontocalth of Classachusetts.
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 Glendon arthur Scotoria „in the Town of Chelmsford (Name of child.)
(City or town.)
(Name of city oy 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 4 1898
Name of father,
John P. Scatoria
Name of child,
Glendon arthur Scatoria
Maiden name of mother,
Catherine S. Cartwright
Residence of parents,
Chelmsford
(at time the birth occurred.)
Occupation of father,
Carpenter
(at time the birth occurred.)
Birthplace of father,
new Brunswick.
Condition (twin, &c.) , ...
Place of birth,
So. Chelmsford
Birthplace of mother,
72.21
SIGNATURE.
John PScolonia So. ilms ford
RESIDENCE.
(City of town, street and number, if any.)
Relation to child, if any. Father
Date, July 14, 1916
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by
are true.
Edward & Bobbing
Clerk
(City or town.)
Recorded
July 14, 1916
Of
Mass.
Sex,
mate
Col
White
83
Commonlocalth of atlassachusetts.
No. 31
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 alice Staveley in the Town of Chelmsford
(Name of child.)
(City or town.)
(Name of city of 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, December 9, 1901
Name of child, alice Staveley
Sex, : Female
Color, White
Occupation of father,
Blacksmith
(at time the birth occurred.)
Birthplace of father,
England
Condition (twin, &c.),
Place of birth,
Chelmsford
Birthplace of mother,
England.
SIGNATURE. Elizabeth Staveley
RESIDENCE.
(City or town, street and number, if any.)
Chelmsford
Relation to child, if any. mother
Date,
117, 1916
Then personally appeared before me the person whose signature appears above and made
oath that the statements subscribed to by her are true.
Edward Robbing (City or town.) . Clerk.
Recorded
Of
Mass.
.. .
Name of father, Benjamin a. Stavalay
Maiden name of mother,
Elizabeth thornton
Residence of parents,
Chelmsford
(at time the birth occurred.)
3
Commonwealth of Classachusetts.
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 James freeth Fox (Same of child.) .... in the Town of Chelmsford
(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. 29, 1897
Name of child, James Joseph For
Sex, male-
Color, White
Condition (twin, &c.),
Place of birth,
Chelmsford
Name of father
John F. Frøy
Maiden name of mother.
Chzabeth a. Coleman
Residence of parents,
Chelmsford
(at time the birth geeurred.)
Occupation of father,
machinist
(at time the birth occurred.)
Birthplace of father,
Ireland
Birthplace of mother,
Jewill Pass
SIGNATURE. Mrs Elizabeth & For
RESIDENCE.
(City or town, street and number, if any.)
Chelmsford
Relation to child, if any. Mother
Date, Orig. 17, 1916
Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by her are true.
Edward . Raffin;
Clerk.
(City of town.)
Recorded
any 17, 1916
Of
Mass.
Commonwealth of glassachusetts.
No. 33
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 Öster Elizabeth Fox
(Name of child.) in the Town of Chelmsford
(City or town.)
(Name of city of 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 20, 1901
Name of child, Ester Elizabeth Fox
Sex, Female
Residence of parents,
Chelmsford
(at time the birth occurred.)
Occupation of father,
machinist
(at time the birth occurred.)
Birthplace of father,
cheland
Birthplace of mother, Korv
Forwell Mass
SIGNATURE.
RESIDENCE.
(City er town, street and number, if any.)
Ma Elizabeth U.Fox Chelm.
Imaford
Relation to child, if any. mother
Date,
1/ 19/6
Then personally appeared before me the person whose signature appear above and made
oath that the statements subscribed to by are true.
Edward &Rolf (cin of town.)
Clerk
Recorded
Cing 17, 1916
of Cheh. ford Mass.
Condition (twin, &c.) , ...
Place of birth,
Chelmsford
Name of father,
Maiden name of mother Che alth a Coleman
Color,
white
Commontucalth of Classachusetts.
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.)
The undersigned on oath depose and say that the record relating to the birth of Rena Elizabeth Chittick in the Town of Chelmsford r Name of child.)
(City or town.)
(Name of city of 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 5, 1981
Name of father,
albert S. Ahitbick
Name of child, Rena Elizabeth Chittick
Maiden name of mother,
anna Vanorhan
Residence of parents,
Chelmsford.
(at time the Mirth occurred.)
Occupation of father,
Flag station. PPK
Vat time the birth occurred.)
Birthplace of father,
Caymans h. M
Birthplace of mother,
Balleton Sha n.M.
SIGNATURE.
albers, Muss
RESIDENCE.
(City or town, street and number, if any.)
Relation to child, if any.
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