| Certificate Number | 562 | | Date Issued |
| Child Given Name | Laura Josephine |
Phares | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Jan 1887 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | J.W. |
Phares | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 33 | Father's Age |
| Mother's Given Name | Didoma | Dickinson | Mother's Maiden Name |
| Mother's Surname | Phares | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Returned by Name | J.I. Hostetter | | |