| Full Name at Birth | Juanita Stoddard Moore |
|---|---|
| Date of Birth | 11 – 20 – 1904 |
| Color or Race | White |
| Birthplace | Bakerton, Jeff., W.Va |
| Father | John McClellan Moore |
| Father’s Birthplace | Washington, Md. |
| Mother | Nora Frances Welsh |
| Mother’s Birthplace | Jeff Co., W.Va. |
| Signature | Juanita S. Horn |
| Subscribed and Sworn | March 22, 1943 |
| Address | Harpers Ferry, W.Va |
| Notary Public | Martin D. Welsh |
| Abstract of Supporting Evidence | 1. Aff. of att. physician S. T. Knott, M.D. (from off. rec.) – Nov. 20, 1904 2. Aff. of Sister, Laura M. Mytinger – Feb. 7, 1943 |
| Color or Race | White. |
| Age of Mother at Time Child Was Born | 31 yrs. |
| Mother’s Birthplace | Jefferson County, W.Va |
| Occupation | Housewife |
| How Many Children Born To This Mother | Two |
| Did any of these children die before this child was born? | No. |
| Signature | |
| Laura Belle Moore | |
Delayed Birth: Juanita Stoddard Moore
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