Date and place of Birth:
Fifth of the Second, Eight Hundred and Twenty One
Imperial Hospital, Leeds
Name: Helene Silver
Sex: Female
Father:
Name and Surname: Unknown
Place of Birth: Unknown
Occupation: Unknown
Mother
Name and Surname: Kalliste Silver
Maiden Name: Silver
Place of Birth: Planet Houston, Texas, Liberty
Occupation: None (Deceased)
Surname at marriage: N/A
Usual Address if different from Place of Birth:
17 Oak lane, Warwick Village, Warwickshire, Cambridge
Informant:
Name and Surname (if not the Mother or Father):
Tara Alexandra Eleanor Nelson Reidman Dagon
Qualification: Grandmother (adoptive)
Usual Address (if different from Above):
27 Shilling Lane, Oxford, Cambridge (Summer Palace)
I certify that the particulars entered above are true to the best of my knowledge and belief:
Date of registration: 27/08/826 A.S
Signature of Witness:
Names given after Registration and surname: Helene Silver-Dagon