8/6/2019 Birth Record Older--Pdf to write in entries

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Moorish Science Temple of AmericaRecord of Live Birth

Let it be known by all men that at __________A.M./ P.M. on

____________________of the Hijiri Calendar, corresponding to

____________________of the Gregorian Calendar, occurred the live birth/

nativity of _______________________________________, a male/ female child,at ______________________[City], in the territory and/or adjoining island of

______________________ in Al Moroc/ Amexum (America).

WHEREFORE the below signed witnesses do attest to and verify all claim to this

live birth/ nativity by these parent-parties:

Mother:__________________________________ and

Father: __________________________________ by their union.

For these witnesses, knowledge of the below facts accompany these claims of this

live birth/ nativity with this truth communication claim by the live-birth party:

:Photo :Fingerprint :Blood/ Saliva

____________ ____________ _______

Witness 1:______________________________________

Witness 2:______________________________________

Witness 3:______________________________________

Seal