| Certificate Number | 266 | | Date Issued |
| Child Given Name | Ida Pearle |
Boynton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 Sep 1885 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Wm H. |
Boynton | Father's Surname |
| Father's Occupation | Drayman | | Father's Nationality |
| Father's Birth Place | Linn Co IA | 23 | Father's Age |
| Mother's Given Name | Ida E. | Lockward | Mother's Maiden Name |
| Mother's Surname | Boynton | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Smith M.D. | Nevada IA | Medical Attendant's Address |