| Certificate Number | 638 | | Date Issued |
| Child Given Name | |
Porter | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 May 1883 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | P.S. |
Porter | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 58 | Father's Age |
| Mother's Given Name | Susan | Dukes | Mother's Maiden Name |
| Mother's Surname | Porter | | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 37 | 5 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |