[Birth Certificate for Richard Pantoja] Page: 1 of 2
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TEXAS DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
CERTIFICATE OF BIRTH
STATE OF TEXAS
,142- 21867
1. PLACE OF BIRTH
a. county
Karris
BIRTH NO.XIW
2. USUAL RESIDENCE OF MOTHER (Whore doea motbar lira?)
a. STATE _ b. COUNTY
b. city (If outside corporate liniita, «rite RUHAL and precinct no.) c, CITY (I<
or OR
town Houtton town
C. full name of (If NOT in hospital or institution, fir® street address or location) d. STREET
hospital or - address
institution a* jA1«nhi| M*t«rnltv
C. CITY (H outside corporst* Units, writs RURAL snd five precinct no.)
T™N • Houston
(If rural, sirs location)
hospital or , address o-j -1
institution at. Joseph's Maternity I g-L1 M°g&n
3. CHILD'S NAME a. (First) b. (Middle) o. (La t)
" Riohard Pantoja
4. SEX 5a. THIS BIRTH TWIN Q 5b. IF TWIN OR TRIPLET (ThleohUd bom) 6. LEGITIMATE T 7. DATE OF BIRTH
Hal a MNOU I3t TRIPLET Q 1ST -Q 2ND Q « □ If#® NOT 23,1964
FATHER OF CHILD ~
8. full name ® (First) b. (Middle) c. (Last) 9. COLOR OR RACE
Albert Panto J a White
10 AGE (At Una ol thla birth) II. BIRTHPLACE (State or foreico oountry) 12a. USUAL OCCUPATION | I? b. KIND OF BUSINESS OR INDUSTRY
27 years Cook
MOTHER OF CHILD
13 FULL MAIDEN NAME a. (First) b. (Middle) c. (Last) 14. COLOR OR RACE
1 White
8. full name
17a. USUAL OCCUPATION
Housewife
ioe Delao _
16. BIRTHPLACE (State or forsiffn country)
Texas
18. CHILDREN PREVIOUSLY BORN TO THIS MOTHER (Do NOT Include this child
a.HowmanyOTHER b. How many OTHER chil- c. How many OTHER , \ ' r f
children are now liv- dren were bom alive but are children were stillborn i L v- ^ '—*— I L *- L v 1 <■
ingT now dead? (born dead after 20 weeks 19b. ADDRESS
2 0 pr^nancj) 2n Hogan, Houston
17 b. KIND OF BUSINESS OR INDUSTRY
20.I hereby certify that I attended the birth of this child who mas born on the
date stated above at 7i49 A. M. kjflftikw&
V
21b. ATTENDANT AT BIRTH
M-oOt-aD MIDWIFE □ (Scorify)
2Id. DATE SIGNED
2419 Canal. Houston
hot 26.1964
22a. REGISTRAR S FILE NO
STATE OF TEXAS'
COUNTY OF HARRIS
I HEREBY CERTIFY THAT THE ABOVE IS A PHOTOSTATIC COPY OF A CERTIFICATE
AS FILED IN THE BUREAU OF VITAL STATISTICS, CITY HEALTH DEPARTMENT,
HOUSTON, TEXAS
ISSUED
DATE
LOCAL RE01 STRAP
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Texas. Bureau of Vital Statistics. [Birth Certificate for Richard Pantoja], legal document, July 26, 1973; (https://texashistory.unt.edu/ark:/67531/metapth249872/m1/1/: accessed May 21, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting Hoston History Research Center at Houston Public Library.