CERTIFICATION OF VITAL RECORD

STATE OF CALIFORNIA
DEPARTAMENT OF PUBLIC HEALTH

CERTIFICATE OF LIVE BIRTH

STATE OF CALIFORNIA
105 1992 009066 USE BLACK INK ONLY 1 1992 37 000521
LOCAL REGISTRATION DISTRICT AND CERTIFICATE NUMBER
STATE FILE NUMBER
1A. NAME OF CHILD-- FIRST NAME 1B. MIDDLE 1C. LAST (FAMILY)
THIS Marco Antonio Cruz Zuñiga
CHILD 2. SEX 3A.T HIS BIRTH SINGLE, TWIN, ETC. 3B. IF MULTIPLE THIS CHILD4A. DATE OF BIRTH --MM/DD/YY 4B. HOUR -- (24 HOUR CLOCK TIME)
1ST 2 ND ETC
Male Single ---
- ADDRESS --- STREET NUMBER, OR LOCATION
5A. PLACE OF BIRTH --- NAME OF HOSPITAL OR FACILITY5B. STREET
01/14/1992 0140
PLACE
OF Paradise Valley Hospital 2400 East Fourth Street
BIRTH 5C CITY 5D. COUNTRY 5E. PLANNED PLACE OF BIRTH
National City San Diego Hospital
6A. NAME OF FATHER -- FIRST (GIVEN)
6B. MIDDLE 6C. LAST (FAMILY) 7. STATE OF BIRTH 8. DATE OF BIRTH
FATHER
OF
CHILD
MOTHER Martin --- Cruz Mexico 07/02/1961
OF
CHILD 9A. NAME OF MOTHER-- FIRST (GIVEN)
-
9B. MIDDLE 9C. LAST MADDEN) 10. STATE OF BIRTH 11. DATE OF BIRTH
06/02/1955
INFORMANT
Silvia
CERTIFY THAT I HAVE REVIEWED THI
STATED INFORMATION AND THAT IT IS
--- Zuñiga Salazar
12A. PARENT OR OTHER INFORMANT --- SIGNATURE
Mexico
12B. RELATIONSHIP TO CHILD 12C. DATE SIGNED
CERTIFICATION TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE
I CERTIFY THAT THE CHILD WAS BORN ALIVE AT
Silvia Zuñiga Mother 01/14/1992
13A. ATTENDANT OR CERTIFIER -- SIGNATURE -- DEGREE OR TITLE 13B. LICENSE NUMBER
THE DATE, HOUR AND PLACE STATED 13C. DATE SIGNED
CERTIFICATION
OF Edward A. laue, M, D. G-055708 01/14/1992
BIRTH 13D. TYPED NAME, TITLE AND CAALING ADDRESS OF ATTENDANT 14. TYPED NAME AND TITLE OF CERTIFIER IF OTHER THAN ATTENDANT

LOCAL
National City, California
15A DATE OF DEATH 15B. STATE FILE NO. 16. LOCAL REGISTRER ---SIGNATURE
--- 17. DATE ACCEPTED FOR REGISTRATION
REGISTRAR (STATE USE ONLY)
Donald G, Ramras, M. D. 01/17/1992

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FECHA DE EMISIÓN:

Esta copia no es valida a menos que presente el borde gravado, fecha, sello y la firma del Condado Registrador.

ALGUNA ALTERACIÓN U OBLITERACIÓN ANULA ESTE CERTIFICADO