| Certificate Number | 706 | | Date Issued |
| Child Given Name | Mable |
Widner | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 18 Jan 1882 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | John |
Weidner | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 30 | Father's Age |
| Mother's Given Name | Adaline | French | Mother's Maiden Name |
| Mother's Surname | Weidner | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Abbey M. Penn | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Abbey M. Penn | Nevada IA | Certificate Signer's Address |
| Returned by Name | Abbey M. Penn | | |