| 3
First Name |
Middle Name |
Last Name |
Alias |
Registration number |
Date of registration |
Date of certification |
Age |
Gender |
Color |
Height- Feet |
Height - Inches |
Marks or scars |
Eye color |
Description of hair |
Speech |
Name of mother |
Color of mother |
Free status of mother |
Name of father |
Free status of father |
Name of spouse |
Free status of spouse |
Name of children |
Free status |
Where emancipated |
Who emancipated |
Place of birth |
Date of birth |
Previous place of registration |
Name of clerk |
Additional information |
Mary |
Ann |
Anderson |
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11 |
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Isabella |
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Armstrong |
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13 |
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James |
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Ash |
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23 |
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