Birth

Baby's Information

* Newborn baby's name

* Date of Birth

* Place of birth, including address

* Birth Weight

* Is the baby male or female?

Male

Female

Parent Information

* Mother's first and last name, including maiden name.

* Father's first and last name

Mother and Father's home address, including city

32°

Sunny

Sunny. High 34F. Winds NW at 10 to 20 mph.

Partly cloudy this evening, then becoming cloudy after midnight. Low 14F. N winds shifting to ESE at 10 to 15 mph.

Cloudy with gusty winds developing during the afternoon. Slight chance of a rain shower. High 39F. Winds SE at 20 to 30 mph.

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Independence Bulletin Journal Birth Form