| Certificate Number | 57 | | Date Issued |
| Child Given Name | |
Harter | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Nov 1888 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Stillwell |
Harter | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Wisconson | 28 | Father's Age |
| Mother's Given Name | Cora | Muse | Mother's Maiden Name |
| Mother's Surname | | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Pennsylvania | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Brooks | Zearing IA | Medical Attendant's Address |