Certificate Number | 337 | | Date Issued |
Child Given Name | Elsie |
Lacy | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 11 May 1886 |
Grant Twp Story Co IA | Place of Birth |
Father's Given Name | Patrick |
Lacy | Father's Surname |
Father's Occupation | Farmer | | Father's Nationality |
Father's Birth Place | Canada | 40 | Father's Age |
Mother's Given Name | Matilda | Mchone | Mother's Maiden Name |
Mother's Surname | Lacy | Grant Twp Story Co IA | Mother's Residence |
Mother's Nationality | | Iowa | Mother's Birth Place |
Mother's Age | 29 | 2 | Number of Child This Mother |
Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
Returned by Name | E.H. Munk | | |