| Certificate Number | 1013 | | Date Issued |
| Child Given Name | |
Thatcher | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Aug 1884 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Olias N. |
Thatcher | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 35 | Father's Age |
| Mother's Given Name | Anna M. | McDowell | Mother's Maiden Name |
| Mother's Surname | Thatcher | | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 29 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Zearing | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |