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... 1. PLACE OF BIRTH STATE OF TEXAS COUNTY OF BURNET TEXAS DEPARTMENT OF HEALTH BUREAU OF VITAL...: Burnet Give Street and Number or Name of Institution 1endell Lee Tarver City Burnet County of BURNET... to This Mother, Including This Birth 1 This Mother, and Now Living 1 Signature... (Certified Copy) -of June record on 195 1V V. V 11Il t y, r Lc1 V_ 17
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