| Certificate Number | 81 | | Date Issued |
| Child Given Name | |
Minkler | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 11 Nov 1880 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Charles Mortimer |
Minkler | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 32 | Father's Age |
| Mother's Given Name | Ella Amelia | White | Mother's Maiden Name |
| Mother's Surname | Minkler | | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 27 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |