| Certificate Number | 131 | | Date Issued |
| Child Given Name | |
Kooser | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Mar 1889 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Samuel C. |
Kooser | Father's Surname |
| Father's Birth Place | Story Co IA | 20 | Father's Age |
| Mother's Given Name | Libbie E. | McLain | Mother's Maiden Name |
| Mother's Surname | | Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Geo. Stitzell | Nevada IA | Medical Attendant's Address |