| Certificate Number | 225 | | Date Issued |
| Child Given Name | |
Sheehey | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Nov 1885 |
Washington Twp Story Co IA | Place of Birth |
| Father's Given Name | Roger |
Sheehey | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ireland | 41 | Father's Age |
| Mother's Given Name | Almina | Fritch | Mother's Maiden Name |
| Mother's Surname | Sheehey | Washington Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Germany | Mother's Birth Place |
| Mother's Age | 36 | 6 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | D.S. Fairchild | Ames IA | Certificate Signer's Address |
| Returned by Name | D.S. Fairchild | | |