Certificate Number | 70 | | Date Issued |
Child Given Name | Ella May |
McCoy | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 30 Jan 1885 |
Colo Story Co IA | Place of Birth |
Father's Given Name | John R. |
McCoy | Father's Surname |
Father's Occupation | Com. Tav. | | Father's Nationality |
Father's Birth Place | West Virginia | 31 | Father's Age |
Mother's Given Name | Annie | O'Donnell | Mother's Maiden Name |
Mother's Surname | McCoy | Colo Story Co IA | Mother's Residence |
Mother's Nationality | | England | Mother's Birth Place |
Mother's Age | 30 | 4 | 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 | | |