Certificate Number | 490 | | Date Issued |
Child Given Name | |
Day | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 16 Jun 1882 |
Collins Twp Story Co IA | Place of Birth |
Father's Given Name | William |
Day | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | New York | 31 | Father's Age |
Mother's Given Name | Mary Ann | Kluie | Mother's Maiden Name |
Mother's Surname | Day | Collins Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | Iowa | Mother's Birth Place |
Mother's Age | 22 | 4 | Number of Child This Mother |
Medical Attendant's Name | L.H. Bennett M.D. | Clyde IA | Medical Attendant's Address |
Certificate Signer's Name | L.H. Bennett M.D. | Clyde IA | Certificate Signer's Address |
Returned by Name | L.H. Bennett M.D. | | |