| Certificate Number | 726 | | Date Issued |
| Child Given Name | |
Bitner | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Jul 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | August |
Bitner | Father's Surname |
| Father's Occupation | Miller | German | Father's Nationality |
| Father's Birth Place | Germany | 43 | Father's Age |
| Mother's Given Name | Jane | Young | Mother's Maiden Name |
| Mother's Surname | Bitner | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | Canadian | Canada | Mother's Birth Place |
| Mother's Age | 35 | 7 | Number of Child This Mother |
| Medical Attendant's Name | Geo Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | Geo Stitzell | | |