Certificate Number | 205 | | Date Issued |
Child Given Name | |
Markly | Child Surname |
Child Sex | Female |
W | Child Race |
Date of Birth | 06 May 1882 |
Ames Story Co IA | Place of Birth |
Father's Given Name | |
| Father's Surname |
Father's Birth Place | United States | | Father's Age |
Mother's Surname | | Ames Story Co IA | Mother's Residence |
Mother's Nationality | | United States | Mother's Birth Place |
Mother's Age | | 5 | Number of Child This Mother |
Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |
Certificate Signer's Name | D.S. Fairchild | Ames IA | Certificate Signer's Address |
Returned by Name | D.S. Fairchild | | |