| Certificate Number | 187 | | Date Issued |
| Child Given Name | Florence Belle |
Robinson | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 12 Jun 1881 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Horace G. |
Robinson | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Indiana | 30 | Father's Age |
| Mother's Given Name | Ellen Charity | Kise | Mother's Maiden Name |
| Mother's Surname | Robinson | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 27 | 2 | Number of Child This Mother |
| Medical Attendant's Name | G.B. Richards | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | G.B. Richards | Nevada IA | Certificate Signer's Address |
| Returned by Name | G.B. Richards | | |