8/6/2019 Birth Record Baby---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.

  ____________________ ____________________ 

Child’s left foot print Child’s right foot print 

Seal

Witness 1:______________________________________ 

Witness 2:______________________________________ 

Witness 3:______________________________________