| Certificate Number | 46 | | Date Issued |
| Child Given Name | |
Lincoln | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Oct 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | J. Rush |
Lincoln | Father's Surname |
| Father's Occupation | Teacher | | Father's Nationality |
| Father's Birth Place | Maryland | 43 | Father's Age |
| Mother's Given Name | Priscilla C. | Hicks | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Vermont? | Mother's Birth Place |
| Mother's Age | 37 | 7 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |