| Certificate Number | 318 | | Date Issued |
| Child Given Name | Minnie |
Scott | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 May 1888 |
Ontario Story Co IA | Place of Birth |
| Father's Given Name | Wm. |
Scott | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 30 | Father's Age |
| Mother's Surname | | Ontario Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |