Certificate Number | 103 | | Date Issued |
Child Given Name | |
Fonks | Child Surname |
Child Sex | Male |
| Child Race |
Date of Birth | 22 Feb 1885 |
Boone Co IA | Place of Birth |
Father's Given Name | C.A. |
Fonks | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Illinois | 28 | Father's Age |
Mother's Given Name | L. | Crane | Mother's Maiden Name |
Mother's Surname | | Boone Co IA | Mother's Residence |
Mother's Nationality | American | Iowa | Mother's Birth Place |
Mother's Age | 22 | 2 | Number of Child This Mother |
Medical Attendant's Name | B.F. Allen | Story City IA | Medical Attendant's Address |
Certificate Signer's Name | B.F. Allen | Story City IA | Certificate Signer's Address |
Returned by Name | B.F. Allen | | |