Family Tree Welborn » Les sources » Certificate (Used for Birth which occurred prior to 1914) State of Arkansas State Board of health Bureau of Vital Statistics #21987
1. Place of Birth County of Montgomery Twonship Montgomery Town or City Stillwater
2. Full Name of Child Henry Loyd Smith 3. Sex Male 4. Twin, Triplet, or other (empty) 5. Number in order of birth (empty) 6. Premature (empty) 7. Legitimate? Yes 8. Date of Birth Nov. 17 1909 9 Father, Full Name Edgar J. Smith 10. Residence Stillwater 11. Color White 12. Father's age 25 years 13. Birthplace Stillwater, Ark. 14. Occupation Farmer (nbrs 15 - 17 not listed on certificate) 18. Mother Full Maiden Name Edith Lucendey Lee 19. Residence Stillwater 20. Color White 21. Mother's age 23 years 22. Birthplace Parish, Arkansas 23. Occupation Housewife. (nbrs 24 - 26 not listed on certificate) 27. Number of children born to this mother including this child 2 Total number now living 2.
I hereby certify that I was attended present at the birth of this child, who was born alive at 6:ooPM on the date above stated. (Signed) Edgar J. Smith (Signed) Edith Lucendey Smith (Address) Lake City, Ark, Route, 1 Date certificate signed July 9, 1940 Filed (indecipherable) 1940 Registrar (indecipherable).
Affidavit of Attending Physician, Midwife, Parent, Nearest Relative or Other Person Havin Knowledge of this Birth. State of Arkansas County of Poinsett Signature Edgar J. Smith Subscribed in my prescence and sworn to before me this 9 day of July 1940 (Signed) H.L. Methon (?) Notary Public (Signed) Henry C. Robinson, Jr., State Registrar *028585
[I received this document 960220. MLW. Charlottesville, VA.]
Description de la source
Certificate (Used for Birth which occurred prior to 1914) State of Arkansas State Board of health Bureau of Vital Statistics #21987
1. Place of Birth County of Montgomery Twonship Montgomery Town or City Stillwater
2. Full Name of Child Henry Loyd Smith 3. Sex Male 4. Twin, Triplet, or other (empty) 5. Number in order of birth (empty) 6. Premature (empty) 7. Legitimate? Yes 8. Date of Birth Nov. 17 1909 9 Father, Full Name Edgar J. Smith 10. Residence Stillwater 11. Color White 12. Father's age 25 years 13. Birthplace Stillwater, Ark. 14. Occupation Farmer (nbrs 15 - 17 not listed on certificate) 18. Mother Full Maiden Name Edith Lucendey Lee 19. Residence Stillwater 20. Color White 21. Mother's age 23 years 22. Birthplace Parish, Arkansas 23. Occupation Housewife. (nbrs 24 - 26 not listed on certificate) 27. Number of children born to this mother including this child 2 Total number now living 2.
I hereby certify that I was attended present at the birth of this child, who was born alive at 6:ooPM on the date above stated. (Signed) Edgar J. Smith (Signed) Edith Lucendey Smith (Address) Lake City, Ark, Route, 1 Date certificate signed July 9, 1940 Filed (indecipherable) 1940 Registrar (indecipherable).
Affidavit of Attending Physician, Midwife, Parent, Nearest Relative or Other Person Havin Knowledge of this Birth. State of Arkansas County of Poinsett Signature Edgar J. Smith Subscribed in my prescence and sworn to before me this 9 day of July 1940 (Signed) H.L. Methon (?) Notary Public (Signed) Henry C. Robinson, Jr., State Registrar *028585
[I received this document 960220. MLW. Charlottesville, VA.]
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