Certificate Number | 484 | | Date Issued |
Child Given Name | |
Jackson | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 05 Sep 1882 |
Lafayette Twp Story Co IA | Place of Birth |
Father's Given Name | Joseph |
Jackson | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Tennessee | 32 | Father's Age |
Mother's Given Name | Kate | Eply | Mother's Maiden Name |
Mother's Surname | Jackson | Lafayette Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
Mother's Age | 31 | 2 | Number of Child This Mother |
Medical Attendant's Name | Rachel Marshall | Gilbert IA | Medical Attendant's Address |
Certificate Signer's Name | Rachel Marshall | Gilbert IA | Certificate Signer's Address |
Returned by Name | Rachel Marshall | | |