| Certificate Number | 135 | | Date Issued |
| Child Given Name | Pearl May |
Menzel | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 19 Apr 1888 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Frank F. |
Menzel | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Freeport IL | 25 | Father's Age |
| Mother's Given Name | Minnie | Johnson | Mother's Maiden Name |
| Mother's Surname | | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Denmark | Mother's Birth Place |
| Mother's Age | 28 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Mead | Colo IA | Medical Attendant's Address |