| Certificate Number | 343 | | Date Issued |
| Child Given Name | Ida Isabel |
Ruby | Child Surname |
| Child Sex | |
| Child Race |
| Date of Birth | 07 Dec 1881 |
| Place of Birth |
| Father's Given Name | John |
Ruby | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 43 | Father's Age |
| Mother's Given Name | Jane | Webb | Mother's Maiden Name |
| Mother's Surname | Ruby | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 45 | | Number of Child This Mother |
| Medical Attendant's Name | Rebecca Atkinson | | Medical Attendant's Address |
| Certificate Signer's Name | Rebecca Atkinson | | Certificate Signer's Address |
| Returned by Name | Rebecca Atkinson | | |