Birth Certificate


Place of Birth County of Montgomery Township of Jefferson or Village of or City of Dayton O		STATE OF OHIO BUREAU OF VITAL STATISTICS CERTIFICATE OF BIRTH
No. R. R. #6 St.		Registration District No.		File No.
- Ward.		Primary Registration District No. 5374		Registered No. 2420
FULL NAME OF CHILD		Miriam A. Shank
Sex of Child Female	Twin, triplet, or other?	Number in order of birth	Legit- imate? Yes	Date of birth Oct, 26, 1915
FATHER			MOTHER
FULL NAME Chas. U. Shank			FULL MAIDEN NAME Maud Neff
RESIDENCE Dayton, Ohio.			RESIDENCE Dayton, Ohio
COLOR OR RACE White	AGE AT LAST BIRTHDAY 30		COLOR OR RACE White	AGE AT LAST BIRTHDAY 30
BIRTHPLACE Jefferson Tp. Montg. Co.			BIRTHPLACE Jefferson Tp. Montg. Co.
OCCUPATION AND INDUSTRY Farmer			OCCUPATION AND INDUSTRY Housewife
NUMBER OF CHILDREN BORN AND LIVING Number of children born alive to this mother, including this child (if born alive) 3			Number of children of this mother living, including this child (if born alive) 3
CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE
I hereby certify that I attended the birth of this child born to Maud Shank and that the child was Alive at 2:08 aM., on the date above stated.
-		(Signature) W. Burnett Weaver
Given name added from a supplemental report 7/22, 1937		Address Miamisburg, O.
-		Filed Nov 9, 1915
-		Registrar A. C. Cusserwitt

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last modified: 98.07.13