| Certificate Number | 950 | | Date Issued |
| Child Given Name | |
Miller | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 Jun 1884 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Orra S. |
Miller | Father's Surname |
| Father's Occupation | Barber | American | Father's Nationality |
| Father's Birth Place | Iowa | 25 | Father's Age |
| Mother's Given Name | Nannie | Ginn | Mother's Maiden Name |
| Mother's Surname | Miller | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Missouri | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.L. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | J.L. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | J.L. Bartlett | | |