| Certificate Number | 153 | | Date Issued |
| Child Given Name | Bertha |
Silvas | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Apr 1881 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | William |
Silvas | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 37 | Father's Age |
| Mother's Given Name | Elizabeth | Kirkendall | Mother's Maiden Name |
| Mother's Surname | Silvas | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 42 | 8 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes | Cam | Certificate Signer's Address |
| Returned by Name | D.D. Hayes | | |