| Certificate Number | 573 | | Date Issued |
| Child Given Name | |
Thomson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Feb 1883 |
Iowa Center Story Co IA | Place of Birth |
| Father's Given Name | L.D. |
Thomson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Mother's Given Name | Sarah | Richardson | Mother's Maiden Name |
| Mother's Surname | Thomson | Iowa Center Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | | 3 | Number of Child This Mother |
| Medical Attendant's Name | B.O. Higby | Iowa Center IA | Medical Attendant's Address |
| Certificate Signer's Name | B.O. Higby | Iowa Center IA | Certificate Signer's Address |
| Returned by Name | B.O. Higby | | |