| Certificate Number | 972 | | Date Issued |
| Child Given Name | Louise Isabell |
Serbein | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Jun 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | John |
Serbein | Father's Surname |
| Father's Occupation | Baker | German | Father's Nationality |
| Father's Birth Place | Germany | | Father's Age |
| Mother's Given Name | Lucy | Hoffman | Mother's Maiden Name |
| Mother's Surname | Serbein | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | | 4 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk | | |