| Certificate Number | 131 | | Date Issued |
| Child Given Name | |
McCall | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 May 1890 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | John N. |
McCall | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Polk Co IA | 32 | Father's Age |
| Mother's Given Name | Olive | Quick | Mother's Maiden Name |
| Mother's Surname | | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Jasper Co IA | Mother's Birth Place |
| Mother's Age | 24 | 4 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |