.H, . 
     
    
   
   
    
     Church Record PfBi'rthS n 
     
    
   
   
    
     Child’s Name i Name of Father Address i Date of Birth E Signature 
     
    
   
   
    
       
     
    
   
   
    
            
     
    
   
   
    
       
     
    
   
   
    
     ‘ i , 
     
     H * '1’, LL 
     
     30M:4'5 5+