Child's Name: Irma Eliza Sampson
Date of Birth: Jan 9th 1897
Place of Birth: Avon
Sex: F
Color: W
Living or Stillborn: Living
No. of Child, 1st, 2nd, etc.: 3rd
Father's Name: Edgar M. Sampson
Father's Birthplace: Medford Mass
Father's Color: W
Father's Residence: Avon
Father's Occupation: Farmer
Mother's Maiden Name: Carrie E Sampson
Mother's Birthplace: Avon Me.
Mother's Color: W
Mother's Occupation: Housework
Name and address of Physician (or other person) reporting said Birth: Mrs Julia D. Pearson
