Certificate Number | 193 | | Date Issued |
Child Given Name | |
Tremaine | Child Surname |
Child Sex | Male |
| Child Race |
Date of Birth | 06 Jun 1881 |
Story City Story Co IA | Place of Birth |
Father's Given Name | Orlando G. |
Tremaine | Father's Surname |
Father's Occupation | Physician | American | Father's Nationality |
Father's Birth Place | Waukesha Co WI | 26 | Father's Age |
Mother's Given Name | Lucy | Ament | Mother's Maiden Name |
Mother's Surname | Tremaine | Story City Story Co IA | Mother's Residence |
Mother's Nationality | American | Hamilton Co IA | Mother's Birth Place |
Mother's Age | 19 | 1 | Number of Child This Mother |
Medical Attendant's Name | O.G. Tremaine | Story City IA | Medical Attendant's Address |
Certificate Signer's Name | O.G. Tremaine | Story City IA | Certificate Signer's Address |
Returned by Name | O.G. Tremaine | | |