| Certificate Number | 592 | | Date Issued |
| Child Given Name | |
Norris | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Jan 1883 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | Fred A. |
Norris | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Eletha | French | Mother's Maiden Name |
| Mother's Surname | Norris | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Jno. I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno. I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno. I. Hostetter | | |