| Certificate Number | 546 | | Date Issued |
| Child Given Name | |
Kulow | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Dec 1882 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | Frederick |
Kulow | Father's Surname |
| Father's Occupation | Farmer | German | Father's Nationality |
| Father's Birth Place | Germany | 56 | Father's Age |
| Mother's Given Name | Adaline | Hunt | Mother's Maiden Name |
| Mother's Surname | Kulow | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 41 | 8 | Number of Child This Mother |
| Medical Attendant's Name | J. Joor | Iowa Center IA | Medical Attendant's Address |
| Certificate Signer's Name | J. Joor | Iowa Center IA | Certificate Signer's Address |
| Returned by Name | J. Joor | | |