Child's Name: [blank]
Date of Birth: Sept 22'd 1893
Place of Birth: Londonderry
Sex: F; Color: W
Living or Stillborn: Living
No. of Child: 2'd
Father's Name: Cha's Alexander
Father's Birthplace: Manchester
Father's Color: W
Father's Residence: Londonderry
Father's Occupation: Occupation
Mother's Maiden Name: Jennie M. Young
Mother's Birthplace: Manchester
Mother's Color: W
Clerk of: Londonderry