| Certificate Number | 307 | | Date Issued |
| Child Given Name | Lizzie A. |
Miller | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Dec 1888 |
Bloomington Story Co IA | Place of Birth |
| Father's Given Name | Thos. J. |
Miller | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 35 | Father's Age |
| Mother's Given Name | Belle | Bisbee | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |