| Certificate Number | 261 | | Date Issued |
| Child Given Name | Sadie Bell |
Lanning | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Dec 1880 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | John Wesley |
Lanning | Father's Surname |
| Father's Occupation | Miller | American | Father's Nationality |
| Father's Birth Place | Indiana | 39 | Father's Age |
| Mother's Given Name | Eliza | Marcellus | Mother's Maiden Name |
| Mother's Surname | Lanning | Sherman & Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 37 | 9 | Number of Child This Mother |
| Medical Attendant's Name | Jane, Mrs. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | Jane, Mrs. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | Jane, Mrs. Bartlett | | |