| Certificate Number | 723 | | Date Issued |
| Child Given Name | Myrtle |
Sowers | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 May 1883 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Thomas J. |
Sowers | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 33 | Father's Age |
| Mother's Given Name | Mary M. | Smith | Mother's Maiden Name |
| Mother's Surname | Sowers | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 30 | 6 | Number of Child This Mother |
| Medical Attendant's Name | S.B., Mrs. Boston | McCallsburg IA | Medical Attendant's Address |
| Certificate Signer's Name | S.B., Mrs. Boston | McCallsburg IA | Certificate Signer's Address |
| Returned by Name | S.B., Mrs. Boston | | |