| Certificate Number | 374 | | Date Issued |
| Child Given Name | Lillie May |
Wilson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | Jan 1882 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Wm |
Wilson | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 54 | Father's Age |
| Mother's Given Name | Martha Ann | Wharten | Mother's Maiden Name |
| Mother's Surname | Wilson | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | | 11 | Number of Child This Mother |
| Medical Attendant's Name | N.H. Graften | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | N.H. Graften | Cambridge IA | Certificate Signer's Address |
| Returned by Name | N.H. Graften | | |