| PLACE OF TRANSCRIPTION: | Rock County Courthouse |
| ADDRESS: | 51 S. Main St. |
| CITY, STATE, ZIP: | Janesville, Wisconsin 53545 |
| PHONE NUMBER: | 608-757-5656 |
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| COUNTY: | Rock |
| VOLUME: | |
| PAGE: | |
| RECORD NO: | VS-#64 |
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| REEL #: | 0260 |
| RECORD #: | 001750 |
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| 1. Full Name of Child | Leoline Irene Godfrey |
| 2. Color | White |
| 3. Sex | Female |
| 4. Name of other Issue(s) Living: | Allen and Iva |
| 5. Full Name of Father: | Joseph S. Godfrey |
| 6. Occupation of Father: | Farmer |
| 7. Full Name of Mother Previous to Marriage: | Lena Brown |
| 8. Hour, Day of Week, of Month, and Year of Birth: | Aug. 18, 1887 |
| 9. Place, Town or Township, and County in Which Born: | Lima Center-Rock County, Wis. |
| 10. Birthplace of Father: | Lima Center |
| 11. Birthplace of Mother: | Lima Center |
| 12. Name of Physician or Person Signing Certificate of Affidavit: | Lena Godfrey |
| 13. Residence of Person Last Named: | Lima Center |
| 14. Date of Certificate of Affidavit: | Feb. 20-1936 |
| 15. Date of Registration: | Feb. 21-1936 |
| 16. Any Additional Circumstances: | ----- |