| Certificate Number | 197 | | Date Issued |
| Child Given Name | Inez Myrtle |
Ball | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 27 Jun 1881 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | A.M. |
Ball | Father's Surname |
| Father's Occupation | Blacksmith | American | Father's Nationality |
| Father's Birth Place | Carroll Co IN | 33 | Father's Age |
| Mother's Given Name | Barbara E. | Hopkins | Mother's Maiden Name |
| Mother's Surname | Ball | Cambridge Story Co IA | Mother's Residence |
| Mother's Nationality | American | Jasper Co MO | Mother's Birth Place |
| Mother's Age | 33 | 3 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes | | |