| Certificate Number | 227 | | Date Issued |
| Child Given Name | Ada P. |
McCord | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 23 Sep 1888 |
Collins Twp Story Co IA | Place of Birth |
| Father's Given Name | Sherman G. |
McCord | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 24 | Father's Age |
| Mother's Given Name | | Clothier | Mother's Maiden Name |
| Mother's Surname | | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |