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STATE OF cATmroIINL% )� <br />CERTIFICATION OF VITAL RECORD rr <br />pan "s ' ' •. 1 st7 3 s / � �, rrimi'A / �''N^ rrIp.m'1 'M' i'TT%^"'/r\ <br />y i • k 88, 89.8 4 9 A Ab (5f 0•.' i j qS QS fgp db, 6 4, QA 5 �115QO 0 8 @ •,,,1 0 t 84;'8.8 , 0 .0§ 7% o1 48', f. . bye h, i,a,�b$..R2� owmocvw, <br />COUNTY OF MONTEREY <br />Salinas, California <br />CERTIFIED COPY OF VITAL RECORDS <br />201601004 <br />3052011014154 AFFIDAVIT TO AMEND A RECORD 3201127000102 <br />NO ERASURES, WHITEOUTS, PHOTOCOPIES <br />STATE FILE NUMBER OR ALTERATIONS LOCAL REGISTRATION NUMBER <br />1.1 <br />0 BIRTH ® DEATH 0 FETAL DEATH <br />TYPE OR PRINT CLEARLY IN BLACK INK ONLY - THIS AMENDMENT BECOMES AN ACTUAL PART OF THE OFFICIAL RECORD <br />PART I INFORMATION TO LOCATE RECORD <br />1A NAME—FIRST 18 MIDDLE <br />ADOLFO E. <br />INFORMATION <br />AS IT APPEARS <br />ON ORIGINAL <br />RECORD <br />PART II <br />SC. LAST <br />ALVARADO <br />3. DATE OF EVENT—MM/OO/CCVY 4 CITY OF EVENT 5 COUNTY OF EVENT <br />01/18/2011 CASTROVILLE I MONTEREY <br />6. FULL NAME OF FATHER/PARENT AS STATED ON ORIGINAL RECORD <br />JUAN-ALVARADO <br />7 FULL NAME OF MOTHER/PARENT AS STATED ON ORIGINAL RECORD <br />SARA-ESTRADA <br />STATEMENT OF CORRECTIONS TO BIRTH, DEATH, OR FETAL DEATH RECORD <br />LIST ONE <br />ITEM PER <br />LINE <br />8 ITEM <br />NUMBER TO BE <br />CORRECTED <br />9 INCORRECT INFORMATION THAT APPEARS ON ORIGINAL RECORD <br />10. CORRECTED INFORMATION AS IT SHOULD APPEAR <br />AKA <br />ADOLFO <br />AKA <br />AKA <br />- <br />ALVARADO ESTRADA <br />29 <br />A. <br />ASUNCION <br />REASON FOR <br />CORRECTION <br />t1 TO CORRECT THE RECORD <br />... <br />AFFIDAVITS <br />AND <br />SIGNATURES <br />PERSONS ONS <br />MUST SIGN <br />THIS FORM TO <br />CORRECT <br />BIRTH, DEATH, <br />DEATH, <br />OR FETAL <br />DEATH <br />RECORD <br />We, the undersigned, hereby certify under penalty of perjury that we have personal <br />that the information given above is true and correct. <br />knowledge of the above facts and <br />12A. SIGNATURE OF FIRST PERSON <br />SV <br />128. PRINTED NAME - <br />ANA B. LOPEZ <br />- 120. TITLE/RELATIONSHIP TO PERSON IN PART I <br />FUNERAL STAFF <br />12D. ADDRESS (STREET ana NUMBER, CITY, STATE, ZIP) <br />41 EAST ALISAL STREET, SALINAS, CA 93901 - <br />12E DATE SIGNED—MM/DDICCYY <br />03/23/2018 <br />13A. SIGNATURE OF SECOND PERSON <br />SV <br />(► <br />. 138. PRINTED NAME <br />WILLIAM LAPORTE <br />13C. TITLE/RELATIONSHIP TO PERSON IN PART I <br />FUNERAL STAFF <br />13D. ADDRESS (STREET and NUMBER, CITY, STATE, ZIP) - <br />41 EAST ALISAL STREET, SALINAS, CA 93901 <br />13E, DATE SIGNED-MM/DD/CCW <br />03/23/2018 <br />STATE/LOCAL ' 14. OFFICE OF VITAL RECORDS OR LOCAL REGISTRAR <br />REGISTRAR STATE REGISTRAR - OFFICE OF VITAL RECORDS <br />USE ONLY R - - <br />STATE OF CALIFORNIA, DEPARTMENT OF PUBLIC HEALTH, OFFICE OF <br />15. DATE ACCEPTED FOR REGISTRATION <br />04/03/2018 <br />VITAL RECORDS i111111EIgdIIIIIIIIIIIIIIIIIIIIUIIUIII3IUBiIlII911lII11II11IIIIIIIIII FORM VS 24a (REV. 1/08) <br />'020101003840199' 1.1 <br />DATE ISSUED <br />Iocal Registrar. <br />This is a true exact reproduction of the document officially registered and placed on file in the Office of the Monterey County Vital Records. <br />This copy is not valid unless prepared on engraved border displaying seal and signature of Local Regstrar. <br />f NCOItn101/14 <br />ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE <br />