Missouri Digital Heritage :: Collections :: Birth & Death Records Database :: Birth Record Detail

Missouri Birth & Death Records Database

Permanent Record of Births

County Roll Number Page Number
Polk C 5519 2098

Date of Return
(Month/Day/Year)
  1. Name of Child
  2. Sex
  3. No. of Child of this Mother
Race or Color
  1. Date of Birth
  2. Place of Birth
Feb 15 1888
  1. Male
  2. 5th
  1. Jan 1, 1888
  2. Polk Co Mo

  1. Nationality of Father
  2. Place of Birth
Age
  1. Nationality of Mother
  2. Place of Birth
Age
  1. American
  2. Polk Co Mo
33
  1. American
  2. Carroll Co Ark
37

  1. Full Name of Mother
  2. Maiden Name of Mother
  3. Residence of Mother
  1. Full Name of Father
  2. Occupation
  1. Name and Address of Medical Attendant
  2. Name and Address of Person making Certificate
  3. Returned by
  1. Lissie Burrows
  2. Lissie Jones
  3. Polk Co Mo
  1. Rastas Burrows
  2. Farmer
  1. A J Baker MD Gulf Polk Co Mo
  2. Do
  3. Do

NOTE
 


Due to possible errors or discrepancies in this abstract it is recommended that researchers request a print copy. To request a copy of this record, please print a copy of this page and mail it to the Missouri State Archives, PO Box 1747, 600 W. Main Street,  Jefferson City, MO  65101 with a check or money order for $1.00 made payable to the Missouri State Archives.  Please include a #10 business size, stamped, self-addressed envelope with each request.  Please submit one photocopy request at a time.
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