| Certificate Number | 251 | | Date Issued |
| Child Given Name | |
Lincoln | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Sep 1888 |
Lincoln Twp Polk Co IA | Place of Birth |
| Father's Given Name | Lester W. |
Lincoln | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 40 | Father's Age |
| Mother's Given Name | | Drake | Mother's Maiden Name |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 35 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |