# SACRAMENTO COUNTY

# SACRAMENTO, CALIFORNIA

# CERTIFICATE OF LIVE BIRTH
STATE BIRTH CERTIFICATE NUMBER
STATE OF CALIFORNIA
LOCAL REGISTRATION DISTRICT AND CERTIFICATE NUMBER

## THIS CHILD

| | 1A. NAME OF CHILD—FIRST | 1B. MIDDLE | 1C. LAST |
| :--- | :---: | :---: | :---: |
| | | | |
| 2. SEX Female | 3A. THIS BIRTH, SINGLE, TWIN | 3B. IF MULTIPLE, THIS CHILD ETC. | 4A. DATE OF BIRTH—MONTH, DAY, YEAR | 4B. HOUR—124 HOUR CLOCK TIME |

## PLACE OF BIRTH

| | 5A. PLACE OF BIRTH—NAME OF HOSPITAL OR FACILITY | 5B. STREET ADDRESS (STREET, NUMBER, OR LOCATION) |
| :--- | :---: | :---: |
| | 5C. CITY OR TOWN | 5D. COUNTY |

## FATHER OF CHILD

| 6A. NAME OF FATHER—FIRST | 6B. MIDDLE | 6C. LAST | 7. STATE OF BIRTH | 8. AGE OF FATHER |
| :--- | :---: | :---: | :---: | :---: |
| | | | | |
| | 9A. NAME OF MOTHER—FIRST | 9B. MIDDLE | 9C. LAST (BIRTH NAME) | 10. STATE OF BIRTH | 11. AGE OF MOTHER |

## PARENT'S CERTIFICATION

| I CERTIFY THAT I HAVE REVIEWED THE STATES INFORMATION AND THAT IT IS TRUE AND CORRECT TO THE REST OF MY KNOWLEDGE | 12A. PARENT OR OTHER INFORMANT—SIGNATURE | 12B. RELATIONSHIP TO CHILD | 12C. DATE Signed |
| :--- | :---: | :---: | :---: |
| I CERTIFY THAT I ATTENDED THIS BIRTH AND THAT THE CHILD WAS BORN ALIVE AT THE HOUR, DATE AND PLACE STATED | 12A. PRESENT OR OTHER ATTENDENT—SIGNATURE—DEGREE OR TITLE | 13B. LICENSE NUMBER | 13C. DATE Signed |

## ATTENDANT'S CERTIFICATION

| T4. | 13D. TYPED NAME AND ADDRESS |
| :--- | :--- |
| | Wm. Miller, M.D. - #1 Scripps Drive, Sacto. CA |

## LOCAL REGISTRAR

| 15. DEATH—ENTER DATE OF DEATH | 16. LOCAL REGISTRAR—SIGNATURE | 17. DATE ACCEPTED FOR REGISTRATION |



GOVERNMENT

EXHIBIT

14

S2 20 Cr. 330 (AJN)



CERTIFIED COPY OF VITAL RECORD

STATE OF CALIFORNIA, COUNTY OF SACRAMENTO

THE GREAT SEAL OF THE STATE OF
CALIFORNIA

EUREKA

This is a true and exact reproduction of the document officially registered and placed on file in the office of the Sacramento County Clerk/Recorder.



DATE ISSUED:



* 0 0 2 0 0 6 3 5 4 *


OCT 06 2021



Alana Olverd





GONNA ALLREED, COUNTY CLERK/REGORDER

SACRAMENTO COUNTY, CALIFORNIA



This copy is not valid unless prepared on an engraved border displaying the date, seal and signature of the County Clerk/Recordant.

COUNTY OF SACRAMENTO
California

EFTA00088946