| Certificate Number | 578 | | Date Issued |
| Child Given Name | |
Boyd | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Jul 1887 |
| Place of Birth |
| Father's Given Name | James I. |
Boyd | Father's Surname |
| Father's Occupation | Butcher | | Father's Nationality |
| Father's Birth Place | Illinois | 34 | Father's Age |
| Mother's Given Name | Josephine | Clement | Mother's Maiden Name |
| Mother's Surname | Boyd | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Jasper Co IA | Mother's Birth Place |
| Mother's Age | 27 | | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffrey | Nevada IA | Medical Attendant's Address |