| Certificate Number | 341 | | Date Issued |
| Child Given Name | Della L. |
Mitchell | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 Feb 1882 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | S.N. |
Mitchell | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 42 | Father's Age |
| Mother's Given Name | Elizabeth | Carr | Mother's Maiden Name |
| Mother's Surname | Mitchell | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 37 | 12 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Monk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Monk | | |