This was found in FamilySearch.org on 18 May 2019.
The image is number 67 of 458, in the record collection for California, County Birth...Death Records, 1800-1994, San Joaquin, Birth certificates 1910 bol 7, no 1-278.
This is from: CALIFORNIA STATE BOARD OF HEALTH, BUREAU OF VITAL STATISTICS, DUPLICATE CERTIFICATE OF BIRTH
Place of Birth: County of San Joaquin
Town of or City: of Roberts Island
State Index No. 44
Local Registered-No. 110
(No...St., Ward) (If birth occurred in a Hospital or Institution, give its NAME of street and number.)
Full Name of Child: Helen Louise Clarke (unnamed) (if child is not yet named, make supplemental report as directed.)
Date of Birth: 6 6 1910
(Month) (Day) (Year)
PERSONAL AND STATISTICAL PARTICULARS
Sex of child: Female Color or Race of Child: white}and{Number in Order of Birth: 4th
Legitimate?: Yes
Father Full Name: D.W. Clarke
Residence: Roberts Island
Color or Race: White
Age at last Birthday: 36 (Years)
Birthplace (State or Country) Indiana
Occupation: Rancher
Mother Full Maiden Name: Annie Schaffer
Residence: Same
Color or Race: White
Age at last Birthday: 35 (Years)
Birthplace: Pennsylvania (State or County)
Occupation: Housewife
Number of Child of this mother: 4
Number of Children, of this mother, now living: 2
CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE
I hereby certify that I attended the birth of this child, and that it occurred on June 6 1910 at 11A.M.
(Signature) J. F. Priestly
{When there was no atending physician or midwife, then the father, householder, etc.. should make this return.}
Given name added from a supplemental report March 20 1953, Martha H. Ochler Registrar
by Esther Rienhart, Dep.
Address: JAMES H. KROH
Filed: June 8 1910 JAMES H. KROH
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