Certificate Number | 214 | | Date Issued |
Child Given Name | Lulu Bell |
Hendrickson | Child Surname |
Child Sex | f |
| Child Race |
Date of Birth | 14 Aug 1881 |
Palestine Twp Story Co iA | Place of Birth |
Father's Given Name | H.O. |
Hendrickson | Father's Surname |
Father's Occupation | Farmer | American | Father's Nationality |
Father's Birth Place | Wisconson | 37 | Father's Age |
Mother's Given Name | Sarah I. | Hanze | Mother's Maiden Name |
Mother's Surname | Hendrickson | Palestine Twp Story Co IA | Mother's Residence |
Mother's Nationality | Norwegian | Skonevig | Mother's Birth Place |
Mother's Age | 30 | 4 | Number of Child This Mother |
Certificate Signer's Name | H.O. Hendrickson | Sheldahl IA | Certificate Signer's Address |
Returned by Name | H.O. Hendrickson | | |