| Certificate Number | 603 | | Date Issued |
| Child Given Name | Bertha E. |
Ball | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 21 Aug 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | A.M. |
Ball | Father's Surname |
| Father's Birth Place | Indiana | 39 | Father's Age |
| Mother's Given Name | Barbara E. | Hopkins | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Missouri | Mother's Birth Place |
| Mother's Age | 39 | 6 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |