| Certificate Number | 54 | | Date Issued |
| Child Given Name | Bertha |
McConnell | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Nov 1887 |
| Place of Birth |
| Father's Given Name | Simeon |
McConnell | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 35 | Father's Age |
| Mother's Given Name | Jennie | Finley | Mother's Maiden Name |
| Mother's Surname | McConnell | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 2 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |