PLACE OF BIRTH CALIFORNIA STATE BOARD of HEALTH State index No. _____
BUREAU OF VITAL STATISTICS
County of Los Angeles Local Registered No. 1337
DUPLICATE CERTIFICATE OF BIRTH
[If birth occurred in a Hospital Or
Institution, give its NAME instead of
street and number.]
City of Huntingon Park
[?] Dr Preston's Home Hospital St; Ward)
[If child is not yet named, make
supplemental report, as directed.]
Name of Child Shirley Cora Triplett
PERSONAL AND STATISTICAL PARTICULARS
Sex of child: Female Twin,Triplet, or other? Number in Order of Birth Legitimate? DATE OF BIRTH July 5 1913 Yes (Month)(Day)(Year)
FULL FULL
NAME FATHER MAIDEN MOTHER
NAME
Shirley Triplett Grace Hortense Rippey
RESIDENCE
916 West 56st Los Angeles RESIDENCE [Same]
COLOR AGE AT LAST COLOR AGE AT LAST
OR RACE W BIRTHDAY 23 OR RACE W BIRTHDAY 23
BIRTHPLACE BIRTHPLACE
(State or Country) Minn (State or Country) Colorado
OCCUPATION OCCUPATION
Electritian Housewife
Number of children born to this mother, including present birth Number of children of this mother now living
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE*
I hereby certify that I attended the birth of this child, who was
born on the date above stated. July 5th 1913 at 4:30 A.M.
(Born alive or Stillborn)
FILED
Aug 6, 1913 C.L. Logan
Registrar
I HEREBY CERTIFY THAT IF IMPRESSED WITH THE SEAL; OF LOS ANGELES COUNTY RECORDER, THIS IS A TRUE COPY OF THE PERMANENT RECORD FILED OR RECORDED IN THIS OFFICE.
DATE MAR 13 1960 FEE $2.00
Ray E. Lee COUNTY RECORDER
LOS ANGELES COUNTY, STATE OF CALIFORNIA
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