| Certificate Number | 179 | | Date Issued |
| Child Given Name | Gladice E. |
Wiggins | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 09 Jul 1890 |
Colo Story Co IA | Place of Birth |
| Father's Given Name | Chas F. |
Wiggins | Father's Surname |
| Father's Occupation | Stock Buyer | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 33 | Father's Age |
| Mother's Given Name | | Stork | Mother's Maiden Name |
| Mother's Surname | | Colo Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 31 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |