Certificate Number | 548 | | Date Issued |
Child Given Name | J.S. |
Dickison | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 02 May 1887 |
Nevada Twp Story Co IA | Place of Birth |
Father's Given Name | James |
Dickison | Father's Surname |
Father's Occupation | Farmer | | Father's Nationality |
Father's Birth Place | Indiana | 34 | Father's Age |
Mother's Given Name | Ritta | King | Mother's Maiden Name |
Mother's Surname | Dickison | Nevada Twp Story Co IA | Mother's Residence |
Mother's Nationality | | Illinois | Mother's Birth Place |
Mother's Age | 29 | 3 | Number of Child This Mother |
Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |
Certificate Signer's Name | J.I. Hostetter | Colo IA | Certificate Signer's Address |
Returned by Name | J.I. Hostetter | | |