| Certificate Number | 295 | | Date Issued |
| Child Given Name | |
Bigelow | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 29 Dec 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | D.W. |
Bigelow | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Miss. | 43 | Father's Age |
| Mother's Given Name | Sarah E. | Moore | Mother's Maiden Name |
| Mother's Surname | Bigelow | | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 36 | 4 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merridith M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merridith M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merridith M.D. | | |