Missouri State Archives
Missouri Birth & Death Records Database
Permanent Record of Births
County
Roll Number
Page
Number
Cass
C 1504
95
1237
Date of Return (Month/Day/Year)
Name of Child
Sex
No. of Child of this Mother
Race or Color
Date of Birth
Place of Birth
Aug 28 1886
Keiney,
male
3
white
Aug 6 86
Belton
Nationality of Father
Place of Birth
Age
Nationality of Mother
Place of Birth
Age
Am
Cass
40
Am
Mo
26
Full Name of Mother
Maiden Name of Mother
Residence of Mother
Full Name of Father
Occupation
Name and Address of Medical Attendant
Name and Address of Person making Certificate
Returned by
Emma J Kieney
McCoy
Belton
Thos J Kieney
machinist
R M Slaughter Belton
NOTE
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