| Certificate Number | 579 | | Date Issued |
| Child Given Name | Mary |
Hartman | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Jun 1887 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Wolfred |
Hartman | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Germany | 40 | Father's Age |
| Mother's Given Name | Lina | Bunker | Mother's Maiden Name |
| Mother's Surname | Hartman | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Germany | Mother's Birth Place |
| Mother's Age | 36 | 8 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |