| Certificate Number | 234 | | Date Issued |
| Child Given Name | |
Vail | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 05 Jan 1886 |
Warren Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm H. |
Vail | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | | Father's Age |
| Mother's Given Name | Martha Bell | Brown | Mother's Maiden Name |
| Mother's Surname | Vail | Warren Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | | 4 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |