1. Father's name. 2. Mother's maiden name. 3. No. of groom's marriage. 1. Full name of mother. 1. Full name of father. Age. 2. Maiden name of mother. 13. Residence of mother. 2. Occupation. 11. Name and address of medical attendant. 2. Name and address of person making certificate. 3. Returned by. 1. No. of license. 1. By whom affidavit, if any, is made. 1. Full name of groom. 1. Age next birthday. 2. Place of residence. 2. Race or color. 2. Date of license. 2. By whom consent to marriage given. 3. Occupation. 3. Place of birth. 1 years.1 1. Nationality of mother. 2. Place of birth. 1Q 2 2 23 1. Full name of bride. 1. Where and when married. 2. Maiden name, if a widow. 2. Race or color. 2. Mother's maiden name. 2. Witnesses. 3. Place of residence. 3. Place of birth. 13. No. of bride's marriage. 3. By whom certified, name and office." 1. Date of return. 1. Age next birthday. 1. Father's name. 2. When registered. 1. Place of burial. Name and residence of physician 2. Date of burial. returning certificate. [FORM 13D.] 1. Name. 1. Age. No. Date of report. 2. Sex and color. 2. Occupation. Month. Day. Year. A. M. or P. M. Single, married, widower or widow. 1. Nationality. Where born. 1. Place of death. 1. Complication. How long resident in this State. Years. 2. Cause of death. 2. Duration of disease. 123 12 1. Sex. 2. Color. 12 1. Name and residence of medical attendant. 2. Name and residence of person making return. 1 2 [FORM 14D.] REGISTER OF PHYSICIANS AND MIDWIVES, COUNTY, IOWA. Residence and P. O. address. When registered. Name. The signature of party is required. School of practice. Give St. and No. if in city or town. Age. Nativity. No. of years in practice. No. of years in practice in Iowa. Name of medical college. Date of graduation. Remarks. [FORM 13.] STATE OF IOWA, RETURN OF A BIRTH. The physician, midwife or person in attendance should immediately return_this_certificate, accurately filled out, to the county clerk. Penalty, $10, if not so certified and County.) returned within 30 days. STATE BOARD OF HEALTH. 1. Full name of child (if any)*. 2. Sex........No. of child of this mother..... 3. Race or color (if not of the white race). 4. Date and place of birth.... 5. Nationality, place of birth and age of each parent... 6. Full name of mother and maiden name........ .Mother's residence.. 7. Full name of father...... 8. Father's occupation... 9. Name of medical or other attendant and address..... Returned by........M. D......... Dated at..... .18 .Residence.... (Chapter 151, Acts Eighteenth General Assembly.) SEC. 2. POWERS OF THE BOARD.-The State Board of Health shall have the general supervision of the interests of the health and life of the citizens of the State. They shall supervise a state registration of marriages, births and deaths, as hereinafter provided; they shall have authority to make such rules and regulations as they may, from time to time, deem necessary for the preservation and improvement of the public health. SEC. 5. DUTY OF PHYSICIANS.-It shall be the duty of physicians and midwives in this State to register their names and post-office address with the clerk of the District and Circuit courts of the county where they reside; and said physicians and midwives shall be required, under penalty of ten dollars ($10), to be recovered in any court of competent jurisdiction in the State at suit of the clerk of the courts, to report to the clerk of the courts within thirty (30) days from the date of their occurrence, all births and deaths which may come under their supervision, with a certificate of the cause of death, and such other facts as the Board may require, in the blank forms furnished, as hereinafter provided. SEC. 6. REPORT OF BIRTHS OR DEATHS.-When any birth or death shall take place, no physician or midwife being in attendance, the same shall be reported by the parent to the clerk of the District and Circuit courts within thirty (30) days from the date of its occurrence, and if a death, the supposed cause of death, or if there be no parent, by the nearest of kin not a minor, or, if none, by the resident householder where the birth or death shall have occurred, under penalty provided in the preceding section of this act. *The given name of child should be certified, if possible, when this certificate is made, and should, in any case, be certified, and registered within a year. +City, number, street and ward, same in towns that have them; township or precinct. 14. Mother's maiden name 15. No. of bride's marriage 16. Married at .in the county of........and State of Iowa, the..... 17. Witnesses to marriage N. B.-At Nos. 8 and 15 state whether 1st, 2d, 33, 4th, etc., marriage of each. At 17 give names of subscribing witnesses to the marriage certificate. If no witnesses, give names of two persons who witnessed the ceremony. .18 We hereby certify that the information above given is correct, to the best of our knowledge and belief. .(Groom.) ...(Bride.) I hereby certify that the above is a correct return of a marriage solemnized by me. Dated at this........day of ........18 This return is to be carefully filled out and attached to and returned with the marriage license. This return does not take the place of the certificate which comes attached to the license, but is in addition thereto. (Chapter 151, Laws, 1880.) SEC. 2. The State Board of Health shall have the general supervision of the interests of the health and life of the citizens. They shall supervise a state registration of marriages, births and deaths. SEC. 4. It shall be the duty of the Board of Health to prepare such forms for the record of births, marriages and deaths as they may deem proper. (Code of 1873.) SEC. 2196. The person solemnizing marriage shall forfeit a like amount (fifty dollars) unless within ninety days after the ceremony he make return thereof to the clerk of the Circuit Court. [FORM 4E.] STATE OF IOWA, PHYSICIAN'S CERTIFICATE OF DEATH. The physician who attended any person in a last illness should immediately return this certificate, accurately filled out to .....County. the county clerk. Penalty $10, if not returned within 30 days. Residence... The attention of physicians is earnestly invited to the following list of diseases, in reference to which the particulars specified are essential to the proper classifica *Erase snch of these as are not required. +City-No., street and ward; same in towns that have them; township or precinct. this book, and law pertaining to coroner's inquests. 18tate primary and immediate cause of death, and examine the list of diseases printed on cover of |