Texas Department of Health
Bureau of Vital Statistics
Certificate of Birth
State of Texas
Place of Birth: Anson, Jones County
Usual Residence of Mother: Anson, Jones County, Texas
Child's Name: Otto K. Lollar
Sex: Male
This Birth: Single
Legitimate: Yes
Date of Birth: February 10, 1919
Father of Child: T. O. Lollar
Father's Color or Race: White
Father's Age: 26
Father's Birthplace: Mississippi
Father's Usual Occupation: Farmer
Father's Kind of Business or Industry: Farming
Full Maiden Name of Mother: Lois Anderson
Mother's Color or Race: White
Mother's Age: 24 years
Mother's Birthplace: Mississippi
Mother's Usual Occupation: Housewife
Children Previously Born To This Mother: 2
Informant: Forest A. Anderson, Box 255, Anson, Texas
Attendant's Signature: D. Williams, M. D., Anson, Texas
Registrar's File No.: 14
Affidavit
State of Texas, County of Jones
Before me on this day appeared Forrest A. Anderson known to me to be the person whose name is signed to the above certificate, who on oath deposes and says that the facts stated in the foregoing certificate are true and correct to the best of his knowledge and belief, and that this certificate is filed for the purpose of correcting the original record of the birth of Not Named at Time of Birth. Signed: Forest A. Anderson 28 Jul 1952, Hazel Dudley, County Clerk, Jones County, Texas, By L. Childs Deputy
Filed: Aug 8, 1952, Texas Department of Health, Bureau of Vital Statistics
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