Triplett Family - Shirley Cora Triplett - page 2

19-11-5M

     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)

(Signature)      Walter A. Preston
Physician or Midwife

Address  Huntington Park

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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