| Certificate Number | 425 | | Date Issued |
| Child Given Name | Florence Eithel |
White | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Jul 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Albert Landon |
White | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 30 | Father's Age |
| Mother's Given Name | Sarah Louisa | Glidden | Mother's Maiden Name |
| Mother's Surname | White | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 25 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Jane, Mrs. Barlett M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | Jane, Mrs. Barlett M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | Jane, Mrs. Barlett M.D. | | |