| Usually or Maybe | U | M |
| Name of Child | 
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| Birth Date and Place |
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| Parent's Names |
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| Mother's Maiden Name |
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| Parent's Ages |
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| Parents' State or Country of Birth |
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| Name of Doctor or Midwife |
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| Don't miss the CLUES! | ||
In 1891, coroners, physicians, and midwives were to report births and deaths (called "returns" to the county auditor. Many went unrecorded. In 1907, the State Center for Health Statistics assumed this responsibility.