| Certificate Number | 171 | | Date Issued |
| Child Given Name | Florence |
Pritcher | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 06 May 1881 |
| Place of Birth |
| Father's Given Name | Wm. |
Pritcher | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 56 | Father's Age |
| Mother's Given Name | Rachel | Shects | Mother's Maiden Name |
| Mother's Surname | Pritcher | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | | Mother's Birth Place |
| Mother's Age | 39 | 6 | Number of Child This Mother |
| Medical Attendant's Name | E. Bowen | Iowa Center IA | Medical Attendant's Address |
| Certificate Signer's Name | E. Bowen | Iowa Center IA | Certificate Signer's Address |
| Returned by Name | E. Bowen | | |