Certificate Number | 594 | | Date Issued |
Child Given Name | Charles Day |
Funk | Child Surname |
Child Sex | Male |
W | Child Race |
Date of Birth | 16 Feb 1883 |
Colo Story Co IA | Place of Birth |
Father's Given Name | Franklin D. |
Funk | Father's Surname |
Father's Occupation | Minister | American | Father's Nationality |
Father's Birth Place | Pennsylvania | 33 | Father's Age |
Mother's Given Name | Serine? V. | Day | Mother's Maiden Name |
Mother's Surname | Funk | Colo Story Co IA | Mother's Residence |
Mother's Nationality | American | Virginia | Mother's Birth Place |
Mother's Age | 26 | 2 | Number of Child This Mother |
Medical Attendant's Name | Jno I. Hostetter | Colo IA | Medical Attendant's Address |
Certificate Signer's Name | Jno I. Hostetter | Colo IA | Certificate Signer's Address |
Returned by Name | Jno I. Hostetter | | |