Certificate Number | 240 | | Date Issued |
Child Given Name | Martha B. |
Omvig | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 26 Nov 1885 |
South of Elsworth Hamilton Co IA | Place of Birth |
Father's Given Name | John |
Omvig | Father's Surname |
Father's Occupation | Laborer | Norwegian | Father's Nationality |
Father's Birth Place | Norway | 18 | Father's Age |
Mother's Given Name | Sophia | Anderson | Mother's Maiden Name |
Mother's Surname | Omvig | Elsworth | Mother's Residence |
Mother's Nationality | Norwegian | Norway | Mother's Birth Place |
Mother's Age | 19 | 1 | Number of Child This Mother |
Medical Attendant's Name | C.W. Allen | Story City IA | Medical Attendant's Address |
Certificate Signer's Name | C.W. Allen | Story City IA | Certificate Signer's Address |
Returned by Name | C.W. Allen | | |