| Certificate Number | 431 | | Date Issued |
| Child Given Name | Minnie Bell |
Scott | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 01 Jun 1882 |
Cambridge Story Co IA | Place of Birth |
| Father's Given Name | Sylvester |
Scott | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 28 | Father's Age |
| Mother's Given Name | Sarah A. | Elliott | Mother's Maiden Name |
| Mother's Surname | Scott | Palestine Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes M.D. | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes M.D. | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes M.D. | | |