| Certificate Number | 982 | | Date Issued |
| Child Given Name | |
Lockwood | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 01 May 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Frank |
Lockwood | Father's Surname |
| Father's Occupation | Engineer | | Father's Nationality |
| Father's Birth Place | | 23 | Father's Age |
| Mother's Given Name | Nettie | MacKentosh | Mother's Maiden Name |
| Mother's Surname | Lockwood | Nevada Story Co IA | Mother's Residence |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | P.W. Farrar | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | P.W. Farrar | Nevada IA | Certificate Signer's Address |
| Returned by Name | P.W. Farrar | | |