| Certificate Number | 405 | | Date Issued |
| Child Given Name | |
Porter | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 15 Jun 1882 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Joseph N. |
Porter | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 33 | Father's Age |
| Mother's Given Name | Sarah J. | Dunn | Mother's Maiden Name |
| Mother's Surname | Porter | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 32 | 4 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merrideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merrideth | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merrideth | | |