| Certificate Number | 59 | | Date Issued |
| Child Given Name | Jessie May |
Smith | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 23 Dec 1887 |
Iowa Center Story Co IA | Place of Birth |
| Father's Given Name | C.F.M. |
Smith | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 22 | Father's Age |
| Mother's Given Name | Isabell A. | Guge | Mother's Maiden Name |
| Mother's Surname | Smith | Iowa Center Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 21 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Frank Thompson | Iowa Center IA | Medical Attendant's Address |