| Certificate Number | 242 | | Date Issued |
| Child Given Name | |
McQuire | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Sep 1890 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Jas. F. |
McGuire | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 29 | Father's Age |
| Mother's Given Name | R. Sophia | Delong | 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 | 25 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Jane L. Bartlett | Ames IA | Medical Attendant's Address |