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 15 1404

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
Sept 4,1885
  1. Female
  2. 4th
blank
  1. Aug 30, 1885
  2. Pleasant Hope, Mo

  1. Nationality of Father
  2. Place of Birth
Age
  1. Nationality of Mother
  2. Place of Birth
Age
  1. U.S.A
  2. Ark.
30
  1. U.S.A
  2. Hickory Co, Mo
29

  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. Mary Violet Saller
  2. Crocket
  3. Pleasant Hope, Mo
  1. Seberw Saller
  2. Mechanic
  1. M.H.Cockron MD - Pleasant Hope, Mo
  2. Dr.
  3. Dr.

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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