212881-1934-Supplementary-Bill-read-a-first-time--Births-and-Deaths-Registration — Page 13

644

FORM NO. 5.

[s. 13 (1).]

Declaration for altering or adding to the name of a child.

I (Name)

(Address)

(Description)

Parent [or guardian] of the child of

and

the

day of

whose birth was registered on

under the

name (s) of

do solemnly, sincerely and

truly declare that I desire

Strike out

(a) to add the name (s) of..

either (a) or (b) as required.

to the above-mentioned

name (s).

:.

(b) to alter the above-mentioned name(s) to

Before me,

(Signed).

(Signed.) A.B.,

Parent [or Guardian].

I (Name)

FORM NO. 6.

Declaration of name of child.

(Address)

(Description)

Parent [or guardian] of the child of

and

on the

day of

Registrar.

(s. 13 (1).]

whose birth was registered

without a name, do solemnly, sincerely and truly declare that the said child has received the name(s) of

and that

I desire that the said name(s) shall be added to the register.

Before me.

(Signed.)

(Signed.) A.B., Parent [or Guardian].

Registrar.

FORM NO. 7.

(s. 13 (2).]

Certificate of registration of alteration of name of child.

I, A.B., Registrar [or Deputy or Assistant Registrar of Births and Deaths, do hereby certify that the name [or names] of by which a child of one C.D. and E.F. was registered on the day of

7

19 has [or have] been altered to and that such alteration has been entered in the

register book.

Dated the

day of

19

,

(Signed.) A.B., a registrar of Births and Deaths.

Fee $1.