| Certificate Number | 442 | | Date Issued |
| Child Given Name | |
Buck | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 16 Dec 1886 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Alex H. |
Buck | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 45 | Father's Age |
| Mother's Given Name | Sarah A. | Craig | Mother's Maiden Name |
| Mother's Surname | Buck | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 44 | 5 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |