Certificate Number | 321 | | Date Issued |
Child Given Name | Violet Marie |
Hartsel | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 06 Jun 1886 |
Story City Story Co IA | Place of Birth |
Father's Given Name | G.W. |
Hartsel | Father's Surname |
Father's Occupation | Drayman | | Father's Nationality |
Father's Birth Place | Indiana | 34 | Father's Age |
Mother's Given Name | Lillian | Lawson | Mother's Maiden Name |
Mother's Surname | Hartsel | Story City Story Co IA | Mother's Residence |
Mother's Nationality | | Pennsylvania | Mother's Birth Place |
Mother's Age | 32 | | Number of Child This Mother |
Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |
Certificate Signer's Name | B.F. Allen | Story City IA | Certificate Signer's Address |
Returned by Name | B.F. Allen | | |