| Certificate Number | 43 | | Date Issued |
| Child Given Name | |
Mitchell | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Sep 1880 |
Story Co IA | Place of Birth |
| Father's Given Name | S.M. |
Mitchell | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | | Father's Age |
| Mother's Given Name | Elizabeth | Carr | Mother's Maiden Name |
| Mother's Surname | Mitchell | Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 36 | 12 | Number of Child This Mother |