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The following Forms among others were adopted by the Board of Health and are now in use throughout the State.

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This Return is to be carefully filled out and attached to and returned with the marriage This return does not take the place of the Certificate which comes attached to the License, but is in addition thereto.

license.

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7. Mother's maiden name.

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9. Full name of Bride.

15. Number of bride's marriage. 16. Married at.

8. Number of groom's marriage.

Maiden name, if a widow

day of.

in the County of .and State of Illinois, the.... 18.

10. Place of residence.

11. Age next birthday... 12. Place of birth

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13. Father's name...

14. Mother's maiden name. 15. Number of bride's marriage. 16. Married at

17.

in the County of.

Witnesses to Marriage,.

and State of Illinois, the....day of.

18.

N. B.-At Nos. 8 and 15 state whether 1st, 2d, 3d, 4th, &c., Marriage of each. At 17 give names of subscribing witnesses to the Marriage Certificate. If no subscribing witnesses, give names of two persons who witnessed the ceremony.

18.. We hereby certify that the information above given is correct, to the best of our knowledge and belief.

(Groom.)

I hereby certify that the above is a correct return of a marriage solemnized by me. Dated at.

this.

this.

.day of.

18.

..day of.

18

}

..(Bride.)

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RETURN OF A BIRTH.

The physician, accoucheur or person in attendance should immediately return this certificate, accurately filled out, to the county clerk. Penalty, $10.00, if not so certified and returned within 30 days.

STATE BOARD OF HEALTH.

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9.

Name of medical or other attendant and ad

9. Name of medical or other attendant and address,

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Returned by Dated at.

.18

Mother's residence.

Residence,

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*The given name of child should be certified, if possible, when this certificate is made, and should, in any case, be certified and registered within a year. +City, number, street and ward; same in towns that have them; township or precinct.

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