Certificate Number | 286 | | Date Issued |
Child Given Name | Florence M. |
Gaugh | Child Surname |
Child Sex | Female |
| Child Race |
Date of Birth | 27 Dec 1881 |
Nevada Twp Story Co IA | Place of Birth |
Father's Given Name | William |
Gaugh | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Missouri | 44 | Father's Age |
Mother's Given Name | Virgin | Hart | Mother's Maiden Name |
Mother's Surname | Gaugh | Nevada Twp Story Co IA | Mother's Residence |
Mother's Nationality | American | Missouri | Mother's Birth Place |
Mother's Age | 38 | 8 | Number of Child This Mother |
Medical Attendant's Name | Mrs. Crane | | Medical Attendant's Address |
Certificate Signer's Name | Wm Gaugh | | Certificate Signer's Address |
Returned by Name | Wm Gaugh | | |