Delayed Birth Registration
Child: Hazel Luciel Grimm
Place of Birth: Sistersville, WV
Date of Birth: Jan. 22, 1902

Father: Santford P. Grimm
PO Address: Sistersville, WV
Birthplace: Meigs, County [Meigs Co., OH]
Occupation: Farmer
Age in Years, last birthday: 31

Mother: Ethel S. Barber
PO Address: Sistersville, WV
Birthplace: Meigs County
Occupation: Housewife
Age in Years, last birthday: 18

Certificate Signed by: Bertha Reed, aunt
Certificate Filed: April 5, 1962303