| Certificate Number | 90 | | Date Issued |
| Child Given Name | Lucy Emma |
Bonner | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Mar 1885 |
Sherman Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm. W. |
Bonner | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 38 | Father's Age |
| Mother's Given Name | Sarah | | Mother's Maiden Name |
| Mother's Surname | Bonner | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 34 | 5 | Number of Child This Mother |
| Medical Attendant's Name | John I. Hostetter | | Medical Attendant's Address |
| Certificate Signer's Name | John I. Hostetter | | Certificate Signer's Address |
| Returned by Name | John I. Hostetter | | |