Certificate Number | 243 | | Date Issued |
Child Given Name | Charlie |
Maxwell | Child Surname |
Child Sex | Male |
| Child Race |
Date of Birth | 29 Aug 1881 |
| Place of Birth |
Father's Given Name | David |
Maxwell | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Ohio | 38 | Father's Age |
Mother's Given Name | Jennie | Walker | Mother's Maiden Name |
Mother's Surname | Maxwell | Union Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | Indiana | Mother's Birth Place |
Mother's Age | 27 | 4 | Number of Child This Mother |
Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
Returned by Name | J.M. Brown | | |