Child Given Name | J. Clarence |
Fry | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 03 Oct 1886 |
Richland Twp Story Co IA | Place of Birth |
Father's Given Name | John Valentine |
Fry | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Iowa | 31 | Father's Age |
Mother's Given Name | Ida May | Kelley | Mother's Maiden Name |
Mother's Surname | | Richland Twp Story 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 | Mrs. Mead | John V. | Medical Attendant's Address |
Certificate Signer's Name | Fry | | Certificate Signer's Address |