Certificate Number | 21 | | Date Issued |
Child Given Name | |
Day | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 01 Aug 1880 |
Milford Twp Story Co IA | Place of Birth |
Father's Given Name | William |
Day | Father's Surname |
Father's Occupation | Farmer | England | Father's Nationality |
Father's Birth Place | Linconshire Eng | | Father's Age |
Mother's Given Name | Clara | Airhart | Mother's Maiden Name |
Mother's Surname | Day | Milford Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | | Mother's Birth Place |
Mother's Age | | 3 | Number of Child This Mother |
Medical Attendant's Name | J.W. Bogges | Nevada IA | Medical Attendant's Address |
Certificate Signer's Name | J.W. Bogges | | Certificate Signer's Address |
Returned by Name | J.W. Bogges | | |