| Certificate Number | 417 | | Date Issued |
| Child Given Name | |
Barnard | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 16 Aug 1882 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | George |
Barnard | Father's Surname |
| Father's Occupation | Farmer | Canadian | Father's Nationality |
| Father's Birth Place | Canada | 26 | Father's Age |
| Mother's Given Name | Mary | McArthur | Mother's Maiden Name |
| Mother's Surname | Barnard | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Age | 36 | 3 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton M.D. | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton M.D. | Zearing IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton M.D. | | |