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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.: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