Certificate Number | 676 | | Date Issued |
Child Given Name | |
May | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 26 May 1883 |
Palestine Twp Story Co IA | Place of Birth |
Father's Given Name | J.A. |
May | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Indiana | 48 | Father's Age |
Mother's Given Name | Luanna | Stratton | Mother's Maiden Name |
Mother's Surname | Maynard | Palestine Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | Indiana | Mother's Birth Place |
Mother's Age | 42 | 10 | Number of Child This Mother |
Medical Attendant's Name | D.D. Hayes | Cambridge IA | Medical Attendant's Address |
Certificate Signer's Name | D.D. Hayes | Cambridge IA | Certificate Signer's Address |
Returned by Name | D.D. Hayes | | |