Certificate Number | 220 | | Date Issued |
Child Given Name | Mary |
Corban | Child Surname |
Child Sex | Female |
| Child Race |
Date of Birth | 23 Aug 1881 |
Colo Story Co IA | Place of Birth |
Father's Given Name | Robert |
Corban | Father's Surname |
Father's Occupation | Gardner | Irish | Father's Nationality |
Father's Birth Place | Ireland | 37 | Father's Age |
Mother's Given Name | Ruth E. | Wilson | Mother's Maiden Name |
Mother's Surname | Corban | Colo Story Co IA | Mother's Residence |
Mother's Nationality | Irish | Ireland | Mother's Birth Place |
Mother's Age | 34 | 7 | Number of Child This Mother |
Medical Attendant's Name | Geo. Frazee | Colo IA | Medical Attendant's Address |
Certificate Signer's Name | Geo. Frazee | Colo IA | Certificate Signer's Address |
Returned by Name | Geo. Frazee | | |