t6e Commonweaft6 of Wassacijusetts
CT 0159578
T'own
Of Lexington
I
Form R-3 01012011
Commonwealth ofJ!.fa ssach usetls Registry of Vital Records and Slatistics
CERTIFICATE OF LIVE BlRrn
Date ofBirth Time ofBinh Plurality Binh Order
Slate File /I Registered /I
2OU024446 289
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Sa MALE
!j CAPE COD HOSPrrAl.
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1
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.:s 27 PARK STREET
BARNSTABLE, MA 02601
First Name Middle Surname FirstName
MAY 01,2012
12:45 PM
SINGLE
ERIK AUSTON SHIN-JIN LORENTZEN
TIA
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Middle Surname
-LORENTZEN
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:
Date ofBirth AUGUST 14, 1965
Surname at Binh or Adoption
Firs/Name
lE Binhplace
Middle
YONG-SAN-GU, SOUTH KOREA BEN HUGO LORENTZEN LORENTZEN FlNNSNES, NORWAY
550 LOWELL STREET, LEXINGTON, MA 02420 Cenifier Name/Tille Type CERTIFIER ONLY RICHARD J ANGELO MD
Lie.1I
Binhplace Resident e
Surname
Surname at Binh Or Adoption
Date of Birth OCfOBER 25, 1969
C"
Date of Record Amendment Dat
71188
...
MAY 18, 2012 CLERK, CITy OF BARNSTABLE
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I hereby certify that J hold the Office of Town Clerk of the Town of Lexington, in the County of Middlesex, and the Commonwealth of Massachusetts, and that the Records of Births, Marriages and Deaths are in my custody, and that the following is a tru e copy from the records as certified .by me.
Witness my hand and the Seal on tbisr?fl4ray of
ofLexing ton,
Y a,
Town Clerk