| Certificate Number | 354 | | Date Issued |
| Child Given Name | |
Reumer | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 05 Feb 1882 |
Palestine Twp Story Co IA | Place of Birth |
| Father's Given Name | Noble H. |
Reumer | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Georgia Ann | Toddd | Mother's Maiden Name |
| Mother's Surname | Reumer | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | P.H. Sharp M.D. | Kelley IA | Medical Attendant's Address |
| Certificate Signer's Name | P.H. Sharp M.D. | Kelley IA | Certificate Signer's Address |
| Returned by Name | P.H. Sharp M.D. | | |