Certificate Number | 468 | | Date Issued |
Child Given Name | Mae Amelia |
Irvine | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 25 Dec 1886 |
Warren Twp Story Co IA | Place of Birth |
Father's Given Name | Johnston |
Irvine | Father's Surname |
Father's Occupation | Farmer | Irish | Father's Nationality |
Father's Birth Place | Ireland | 29 | Father's Age |
Mother's Given Name | Tena | Menzel | Mother's Maiden Name |
Mother's Surname | Irvine | Warren Twp Story Co IA | Mother's Residence |
Mother's Nationality | German | Germany | Mother's Birth Place |
Mother's Age | 27 | 3 | Number of Child This Mother |
Medical Attendant's Name | Henry McClain | McCallsburg IA | Medical Attendant's Address |
Certificate Signer's Name | P. McLain | | Certificate Signer's Address |