Certificate Number | 231 | | Date Issued |
Child Given Name | |
Eastman | Child Surname |
Child Sex | |
| Child Race |
Date of Birth | 19 Sep 1881 |
Grant Twp Story Co IA | Place of Birth |
Father's Given Name | Otis |
Eastman | Father's Surname |
Father's Occupation | Farmer | | Father's Nationality |
Mother's Given Name | Otis | | Mother's Maiden Name |
Mother's Surname | Eastman | Grant Twp Story Co IA | Mother's Residence |
Mother's Age | | 9 | Number of Child This Mother |
Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
Returned by Name | E.H. Munk | | |