| Certificate Number | 239 | | Date Issued |
| Child Given Name | Rachel |
Wing | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Aug 1881 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Louis T. |
Wing | Father's Surname |
| Father's Occupation | Farmer | Norwegian | Father's Nationality |
| Father's Birth Place | | 34 | Father's Age |
| Mother's Given Name | Martha | Wing | Mother's Maiden Name |
| Mother's Surname | Sheldahl | | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hayes | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hayes | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hayes | | |