Certificate Number | 770 | | Date Issued |
Child Given Name | |
Corkins | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 30 Sep 1883 |
Washington Twp Story Co IA | Place of Birth |
Father's Given Name | John |
Corkins | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Ohio | 41 | Father's Age |
Mother's Given Name | Cynthia A. | Van Scoy | Mother's Maiden Name |
Mother's Surname | Corkins | Washington Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | Ohio | Mother's Birth Place |
Mother's Age | 36 | 5 | Number of Child This Mother |
Medical Attendant's Name | S. Bradley | Ames IA | Medical Attendant's Address |
Certificate Signer's Name | S. Bradley | Ames IA | Certificate Signer's Address |
Returned by Name | S. Bradley | | |