| Certificate Number | 13 | | Date Issued |
| Child Given Name | |
McNaughton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 28 Oct 1884 |
Boone Co IA | Place of Birth |
| Father's Given Name | David |
McNaughton | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Clinton Co IA | 24 | Father's Age |
| Mother's Given Name | Mary J. | Zenor | Mother's Maiden Name |
| Mother's Surname | McNaughton | Jackson Twp Boone Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |