| Certificate Number | 527 | | Date Issued |
| Child Given Name | |
Newhard | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 18 Mar 1887 |
Walnut Grove IA | Place of Birth |
| Father's Given Name | W.H. |
Newhard | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Julia M. | Hakes | Mother's Maiden Name |
| Mother's Surname | Newhard | Walnut Grove IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |