| Certificate Number | 163 | | Date Issued |
| Child Given Name | Olie May |
Wright | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 28 Apr 1881 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Charles Thomas |
Wright | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Adams Co OH | 27 | Father's Age |
| Mother's Given Name | Mary Elizabeth | Guthrie | Mother's Maiden Name |
| Mother's Surname | Wright | Lincoln Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Adams Co OH | Mother's Birth Place |
| Mother's Age | 22 | 2 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Lincoln Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | F.S. Newton | Lincoln Twp IA | Certificate Signer's Address |
| Returned by Name | F.S. Newton | | |