| Certificate Number | 60 | | Date Issued |
| Child Given Name | Iva? |
Ruth | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 19 Oct 1889 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | D.M. |
Ruth | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | Lake Co IL | 42 | Father's Age |
| Mother's Given Name | Ida J. | Hillman | Mother's Maiden Name |
| Mother's Surname | | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Vermont | Mother's Birth Place |
| Mother's Age | 35 | 5 | Number of Child This Mother |
| Medical Attendant's Name | E.C. Scott | Maxwell IA | Medical Attendant's Address |