| Certificate Number | 698 | | Date Issued |
| Child Given Name | Arthur Forest |
Miller | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 25 May 1883 |
Sheldahl Story Co IA | Place of Birth |
| Father's Given Name | Edward F. |
Miller | Father's Surname |
| Father's Occupation | Merchant | American | Father's Nationality |
| Father's Birth Place | Iowa | 23 | Father's Age |
| Mother's Given Name | Hattie E. | McIntosh | Mother's Maiden Name |
| Mother's Surname | Miller | Sheldahl Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Jer A. Anderson | Sheldahl IA | Medical Attendant's Address |
| Certificate Signer's Name | Jer A. Anderson | Sheldahl IA | Certificate Signer's Address |
| Returned by Name | Jer A. Anderson | | |