Certificate Number | 504 | | Date Issued |
Child Given Name | Susan |
Kersey | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 02 Nov 1882 |
Illinois Grove Story Co IA | Place of Birth |
Father's Given Name | Simon |
Kersey | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Iowa | 32 | Father's Age |
Mother's Given Name | Ida A. | Ufford | Mother's Maiden Name |
Mother's Surname | Kersey | Liberty Twp Marshall Co IA | Mother's Residence |
Mother's Nationality | American | Iowa | Mother's Birth Place |
Mother's Age | | 1 | Number of Child This Mother |
Medical Attendant's Name | A.W. Brooks M.D. | Zearing IA | Medical Attendant's Address |
Certificate Signer's Name | A.W. Brooks M.D. | Zearing IA | Certificate Signer's Address |
Returned by Name | A.W. Brooks M.D. | | |