15-11-26618
I am Adoptee

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Adoptees DOB 10/19/1971

Adoptee Name at Birth Baby Girl Jackson

City & State of Birth Miami, FL

County/Province of Birth Dade

Country USA

BM Name at Adoptees Birth _____ Jackson
or possibly Barbara Jackson

Hospital North Miami General Hospital
Dr S I Kemp & Dr Gary M Bong

Adoption Agency Private adoption

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JO