STATE OF FLORIDA

THIS DOCUMENT HAS A LIGHT BACKGROUND ON TRUE WATERMARKED PAPER. HOLD TO LIGHT TO VERIFY FLORIDA WATERMARK.
BUREAU of VITAL STATISTICS

CERTIFICATION OF BIRTH
STATE FILE NUMBER: 109-2023-055167 DATE ISSUED: JULY 26,2023
DATE FILED: APRIL 5,2023
CHILD'S INFORMATION
NAME: SALOME MARQUEZ RODRIGUEZ

DATE OF BIRTH: APRIL 3,2023 TIME OF BIRTH (24 HOUR): 1115

SEX: FEMALE BIRTH WEIGHT: 8 LBS 2 OZ

PLACE OF BIRTH: HOSPITAL

ADVENTHEALTH ORLANDO
CITY,COUNTY OF BIRTH: ORLANDO,ORANGE COUNTY

OESYHE HO0HELTY MOTHER'S/PARENT'S INFORMATION WOID IF ALTERED OR ERASED

(NAME PRIOR TO FIRST MARRIAGE, IF APPLICABLE)
NAME: IRMA SUSANA RODRIGUEZ RAMOS

DATE OF BIRTH: OCTOBER 21,1998

뜨
OIOA BIRTHPLACE: GUATEMALA
FATHER'S/PARENT'S INFORMATION
(NAME PRIOR TO FIRST MARRIAGE, IF APPLICABLE)
NAME: WILMER ISAI MARQUEZ LORENZO

DATE OF BIRTH: SEPTEMBER 28,1995

BIRTHPLACE: GUATEMALA

Kul , STATE REGISTRAR REQ: 2025513041

THE ABOVE SIGNATURE CERTIFIES THAT THIS IS A TRUE AND CORRECT COPY OF THE OFFICIAL RECORD ON FILE IN THIS OFFICE

WARNING:THIS DOCUMENT IS PRINTD OR PHOTOCOPIED ON SECURITY PAPER WITH WATERMARKS OF THE GREAT

THERMOCHROMIC FL THE BACK CONTAINS SPECIAL LINES WITH TEXT. THE DOCUMENT WILL NOT PRODUCE
A COLOR COPY.

DH FORM 1946 (03-13)

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