| Certificate Number | 37 | | Date Issued |
| Child Given Name | Nina |
McDowell | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 01 Nov 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Robt. |
McDowell | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Ohio | 56 | Father's Age |
| Mother's Given Name | Matilda | Petry | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 37 | 5 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |