CITY AND COUNTY OF
SAN FRANCISCO
_____________________________
CERTIFICATE OF LIVE BIRTH
STATE OF CALIFORNIA
STATE FILE NUMBER
THIS
CHILD
1B. MIDDLE
JESSICA
MARIE
PLACE
OF
BIRTH
FATHER
OF
CHILD
MOTHER
OF
CHILD
1C. LAST (FAMILY)
ALBA
3A. THIS BIRTH, SINGLE, TWIN, ETC. 3B. IF MULTIPLE, THIS CHILD 1ST, 2ND, ETC.
FEMALE
LOCAL REGESTRATION DISTRICT AND CERTIFICATE NUMBER
USE BLACK INK ONLY
1A. NAME OF CHILD — FIRST (GIVEN)
2. SEX
1200338002143
--
SINGLE
4A. DATE OF BIRTH—MM/DD/YYYY
4B. HOUR—(24 HOUR CLOCK TIME)
10/08/1988
0201
5A. PLACE OF BIRTH — NAME OF HOSPITAL OR FACILITY
5B. STREET ADDRESS — STREET, NUMBER, OR LOCFATION
SAN FRANCISCO GENERAL HOSPITAL
1001 POTRERO AVE
5C.
5D. COUNTY
5E. PLANNED PLACE OF BIRTH
SAN FRANCISCO
HOSPITAL
CITY
SAN FRANCISCO
6A. NAME OF FATHER — FIRST (GIVEN)
6B. MIDDLE
6C. LAST (FAMILY)
7. STATE OF BIRTH
8. DATE OF BIRTH
MARK
MIDDLE NAME
ALBA
CALIFORNIA
01/23/1964
9A. NAME OF MOTHER — FIRST (GIVEN)
9B. MIDDLE
9C. LAST (MADEN)
10. STATE OF BIRTH
11. DATE OF BIRTH
LAST NAME
CALIFORNIA
11/22/1966
CATHERINE
MIDDLE NAME
I CERTIFY THAT I HAVE REVIEWED THE STATED
12A. PARENT OR OTHER INFORMANT — SIGNATURE
INFORMANT
CERTIFICATION INFORMATION AND THAT IT IS TRUE AND CORRECT
TO THE BEST OF MY KNOWLEDGE
I CERTIFY THAT THE CHILD WAS BORN ALIVE AT THE
13A. ATTENDANT OR CERTIFIER — SIGNATURE — DEGREE OR TITLE
CERTIFICATION DATE, HOUR AND PLACE STATED.
OF
13D. TYPED NAME, TITLE AND MAILING ADDRESS OF ATTENDANT
BIRTH
CATHERINE ALBA
Signature
INSERT Signature
12B. RELATIONSHIP TO CHILD
12C. DATE SIGNED
MOTHER
10/10/1988
13B. LICENSE NUMBER
13C. DATE SIGNED
RESIDENT
10/10/1988
14. TYPED NAME AND TITLE OF CERTIFIER IF OTHER THAN ATTENDANT
EVE ZARTITSKY, MD, 1001 POTRERO AVE., S.F.
LOCAL
REGISTRAR
15A. DATE OF DEATH
MARIE
15B. STATE FILE NO.
(STATE USE ONLY)
16. LOCAL REGISTRAR -- SIGNATURE
10/12/1988
MITCHELL KATZ, M.D.
STATE OF CALIFOFRNIA, CITY AND COUNTY OF SAN FRANCISCO
This is to certify that the image reproduced hereupon is a true copy
of the record on file in the SAN FRANCISCO DEPARTMENT OF
PUBLIC HEALTH as of the date issued.
DATE ISSUED
17. DATE ACCEPTED FOR REGISTRATION
2006 OCT 31 PM 10:44
Mitchell Katz, M.D.
Health Officer and local Registrar
This copy is not valid unless prepared on security paper with colored background, displaying the date, seal and signature of the City and County Health Officer.