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documents/id/nichol/nichol_birth_cert_2023.md

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+---
+type: identity-document
+category: birth-certificate
+person: Nichol Li
+date: 2023-11-22
+source: nichol_birth_cert_2023.pdf
+---
+
+# Certificate of Live Birth — Nichol Li
+
+**State of California, County of Los Angeles, Department of Public Health**
+
+**State File Number:** 1202319076052
+
+## Child Information
+
+| Field | Value |
+|-------|-------|
+| 1A. Name of Child - First | NICHOL |
+| 1B. Middle | — |
+| 1C. Last | LI |
+| 2. Sex | MALE |
+| 3A. This Birth: Single, Twin, etc. | SINGLE |
+| 3B. If Multiple, This Child 1st, 2nd, etc. | — |
+| 4A. Date of Birth - MM/DD/CCY | 11/22/2023 |
+| 4B. Hour - 24 Hour Clock Time | 2345 |
+
+## Place of Birth
+
+| Field | Value |
+|-------|-------|
+| 5A. Place of Birth - Name of Hospital or Facility | USC ARCADIA HOSPITAL |
+| 5B. Street Address - Street and Number, or Location | 300 W. HUNTINGTON DR |
+| 5C. City | ARCADIA |
+| 5D. County | LOS ANGELES |
+
+## Parent 1 (Father)
+
+| Field | Value |
+|-------|-------|
+| 6A. Name of Parent - First | CHENG |
+| 6B. Middle | — |
+| 6C. Last - Birth Name | LI |
+| 7. Birthplace - State/Country | CHINA |
+| 8. Date of Birth | 06/16/1987 |
+| Relationship to Child | FATHER |
+
+## Parent 2 (Mother)
+
+| Field | Value |
+|-------|-------|
+| 9A. Name of Parent - First | XIANG |
+| 9B. Middle | — |
+| 9C. Last - Birth Name | ZHANG |
+| 10. Birthplace - State/Country | CHINA |
+| 11. Date of Birth | 03/16/1990 |
+| Relationship to Child | MOTHER |
+
+## Informant and Birth Certification
+
+| Field | Value |
+|-------|-------|
+| 12A. Parent or Other Informant - Signature | CHENG LI |
+| 12B. Relationship to Child | FATHER |
+| 12C. Date Signed | 11/23/2023 |
+| — | XIANG ZHANG |
+| Relationship | MOTHER |
+| Date Signed | 11/23/2023 |
+| 13A. Attendant/Certifier - Signature and Degree or Title | BESSIE NHAN, BIRTH. REG. |
+| 13B. Number | A64425 |
+| 13C. Date Signed | 11/24/2023 |
+| 13D. Typed Name, Title and Mailing Address of Attendant | CINDY HUANG CHOU, MD, 207 S SANTA ANITA ST STE 335, SAN GABRIEL, CA 91776 |
+| 14. Typed Name and Title of Certifier if Other Than Attendant | BESSIE NHAN, BIRTH. REG. |
+| 16. Local Registrar - Signature | MUNTU DAVIS MD |
+| 17. Date Accepted for Registration | 11/27/2023 |
+
+## Certification
+
+**CERTIFIED COPY OF VITAL RECORD** — State of California, County of Los Angeles
+
+This is a true certified copy of the record filed in the County of Los Angeles Department of Public Health if it bears the Registrar's signature in purple ink.
+
+- Health Officer and Registrar: VG, MD
+- Date Issued: NOV 27, 2023
+- Barcode: *004097660*
+
+Seal of the County of Los Angeles and State of California present.
+
+"This copy not valid unless prepared on engraved border displaying seal and signature of Registrar."
+"ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE"