Certificate Number | 310 | | Date Issued |
Child Given Name | |
Kittleson | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 03 Jan 1882 |
Sheldahl Story Co IA | Place of Birth |
Father's Given Name | W.O. |
Kitleson | Father's Surname |
Father's Occupation | Railroad Contractor | Norwegian | Father's Nationality |
Father's Birth Place | Norway | 41 | Father's Age |
Mother's Given Name | Fannie F. | Tomilson | Mother's Maiden Name |
Mother's Surname | Kitleson | Sheldahl Story Co IA | Mother's Residence |
Mother's Nationality | American | New York | Mother's Birth Place |
Mother's Age | 35 | 5 | Number of Child This Mother |
Medical Attendant's Name | J.A. Anderson M.D. | | Medical Attendant's Address |
Certificate Signer's Name | J.A. Anderson | | Certificate Signer's Address |
Returned by Name | J.A. Anderson | | |