Certificate Number | 542 | | Date Issued |
Child Given Name | Chume Iranie |
Anderson | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 08 Dec 1882 |
Colo Story Co IA | Place of Birth |
Father's Given Name | Emery E. |
Anderson | Father's Surname |
Father's Occupation | Clerk | American | Father's Nationality |
Father's Birth Place | Illinois | 20 | Father's Age |
Mother's Given Name | Harriet F. | Moore | Mother's Maiden Name |
Mother's Surname | Anderson | Colo Story Co IA | Mother's Residence |
Mother's Nationality | American | Illinois | Mother's Birth Place |
Mother's Age | 27 | 1 | Number of Child This Mother |
Medical Attendant's Name | Jno I. Hostetter | Colo IA | Medical Attendant's Address |
Certificate Signer's Name | Jno I. Hostetter | Colo IA | Certificate Signer's Address |
Returned by Name | Jno I. Hostetter | | |