1913 public laws – Ch.109 Sec.14

That the certificate of birth shall contain the following items, which are hereby declared necessary for the legal, social, and sanitary purposes subserved by registration records: -1 Place of birth, including state, county, township or town, village or city. If in a city, the ward, street, and house number; if in a hospital or other institution, the name of the same to be given, instead of the street and house number. -2 Full name of child. If the child dies without a name before the certificate is filed, enter the surname preceded by Unnamed. If the living child has not yet been named at the date of filing certificate of birth, the space for full name of child is to be left blank, to be filled out subsequently by a supplemental report, as hereinafter provided. -3 Sex of child. -4 Whether a twin, triplet, or other plural birth. A separate certificate shall be required for each child in case of plural births. -5 For plural births, number of each child in order of birth. -6 Legitimate or illegitimate: Provided, that in illegitimate births the word illegitimate shall be written across the face of : the certificate and all items on the certificate which would in any | way reveal the identity of the father, mother, or illegitimate child. itself shall be omitted. -7 Date of birth, including the year, month and day. rot] -8 Full name of father: Provided, that if the child is illegitimate, the name of the putative father shall not be entered without his consent, but the other particulars relating to the putative: father (items nine to thirteen) may be entered if known, otherwise as Unknown. -9 Residence of father. -10 Color or race of father. -11 Educational attainmentsilliterate, able to read and write, common school education or equivalent, high school education or equivalent, college education or equivalent. -12 Age of father at last birthday, in years. -13 Birthplace of father; at least state or foreign country, if known. ; -14 Occupation of father. The occupation to be reported if engaged in any remunerative employment, with the statement of (a) trade, profession, or particular kind of work; (b) general nature.of industry, business or establishment in which employed (or employer). -14 Maiden name of mother. -16 Residence of mother. -17 Color or race of mother. i -18 Educational attainmentsilliterate, able to read and write, common school education or equivalent, high school. education or equivalent, college education or equivalent. -19 Age of mother at last birthday, in years. -20 Birthplace of mother; at least state or foreign ccuntry, if known. -21 Occupation of mother. The occupation to be reported if engaged in any remunerative employment, with the statement of (a) trade, profession, or particular kind of work; (b) general nature of industry, business or establishment in which employed (or employer). -22 Number of children born to this mother, including present birth. – -23 Number of children of this mother living. -24 The certification of attending physician or midwife as to attendance at birth, including statement of year, month, day (as given in item seven), and hour of birth, and whether the child was born alive or stillborn. This certification shall be signed by the attending physician or midwife, with date of signature and address; if there is tio physician or midwife in attendance, then by the father or mother of the child, householder, owner of the premises, or manager or superintendent of public or private institution where the birth occurred, or other competent person, each in the order named, whose duty it shall be to notify the local registrar of such birth, as required by section thirteen of this act. -25 Exact date of filing in office of local registrar, attested by his official signature, and registered number of birth, as hereinafter provided.