| Certificate Number | 472 | | Date Issued |
| Child Given Name | |
Beedle | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 31 Oct 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | James A. |
Beedle | Father's Surname |
| Father's Occupation | Section Boss | American | Father's Nationality |
| Father's Birth Place | Indiana | 26 | Father's Age |
| Mother's Given Name | Mary E. | Sutter | Mother's Maiden Name |
| Mother's Surname | Beedle | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 22 | 3 | 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. | | |