| Certificate Number | 164 | | Date Issued |
| Child Given Name | Ella May |
Wiltse | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 22 Apr 1881 |
Kelley Story Co IA | Place of Birth |
| Father's Given Name | John J. |
Wiltse | Father's Surname |
| Father's Occupation | Lumber Dealer | American | Father's Nationality |
| Father's Birth Place | Greene Co NY | 39 | Father's Age |
| Mother's Given Name | Elizabeth N. | Templeton | Mother's Maiden Name |
| Mother's Surname | Wiltse | Kelley Story Co IA | Mother's Residence |
| Mother's Nationality | American | Fayette Co IA | Mother's Birth Place |
| Mother's Age | 34 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |