Page:UKSRO 1899 (Part II).pdf/779

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Form of Return of Births of Infants.
1655

2. Forms.


ORDER OF THE REGISTRAR GENERAL OF BIRTHS AND DEATHS IN IRELAND , PRESCRIBING FORM OF RETURNS OF BIRTHS OF INFANTS UNDER 12 MONTHS OF AGE.

Union of . District of .

Return of all BIRTHS Registered during the Month of made under the Vaccination Amendment (Ireland) Act, 42 and 43 Vict., c. 70, s. 11.

Note—The Cols, in Division I, and II. of this form are to be filled up by the Registrar. Provision is made in Div. II. for the Registrar's Minute, showing the date of giving the Notice, and to whom given.

[ The Registrar of Births and Deaths for any place, not being the Dispensary Medical Officer of the District, is to send this Return to each Dispensary Medical Officer whose District is wholly or partly comprised in such Registrar's District. ]

I. Extracts from the Register Book of Births relating to each Child. II. Minutes of Notice given pursuant to the Vaccination Act 26 & 27 Vict., c. 52. s. 8.
No. in Birth Register When born. Where born.[1] Name if any of child Sex Name and Surname of the Father or (if the child be illegitimate) of the Mother Rank, Profession or Occupation of Parent When given To whom given
1. 2. 3. 4. 5. 6. 7. 8. 9.
                 
                 
                 
                 
                 


I certify that this is a true Return. Witness my hand this day of , 18

Registrar.

  1. ↑ Be careful to insert such particulars as will enable the Medical Officer readily to find the address.
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