Certificate Number | 682 | | Date Issued |
Child Given Name | John Melvin |
Ulch | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | |
Nevada Story Co IA | Place of Birth |
Father's Given Name | Simon Peter |
Ulch | Father's Surname |
Father's Occupation | Farmer | | Father's Nationality |
Father's Birth Place | | 37 | Father's Age |
Mother's Given Name | Sarah Ann | Strachen | Mother's Maiden Name |
Mother's Surname | Ulch | Story Co IA | Mother's Residence |
Mother's Age | 33 | 3 | Number of Child This Mother |
Medical Attendant's Name | Abbey M. Penn | Nevada IA | Medical Attendant's Address |
Certificate Signer's Name | Abbey M. Penn | Nevada IA | Certificate Signer's Address |
Returned by Name | Abbey M. Penn | | |