| Certificate Number | 312 | | Date Issued |
| Child Given Name | Mary E. |
McKelvie | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 19 Dec 1881 |
New Albay Twp Stor Co IA | Place of Birth |
| Father's Given Name | John |
McKelvie | Father's Surname |
| Father's Occupation | Farmer | Scottish | Father's Nationality |
| Father's Birth Place | Scotland | 25 | Father's Age |
| Mother's Given Name | Minnie H. | Porter | Mother's Maiden Name |
| Mother's Surname | McKelvie | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 25 | 1 | Number of Child This Mother |
| Medical Attendant's Name | George Frazee M.D. | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | George Frazee M.D. | Colo IA | Certificate Signer's Address |
| Returned by Name | George Frazee M.D. | | |