| Certificate Number | 978 | | Date Issued |
| Child Given Name | Mabel |
Will | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 Jun 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Albert M. |
Will | Father's Surname |
| Father's Occupation | Blacksmith | American | Father's Nationality |
| Father's Birth Place | Indiana | 22 | Father's Age |
| Mother's Given Name | Maggie | Tetweler | Mother's Maiden Name |
| Mother's Surname | Will | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 17 | 1 | Number of Child This Mother |
| Medical Attendant's Name | P.W. Farrar | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | P.W. Farrar | Nevada IA | Certificate Signer's Address |
| Returned by Name | P.W. Farrar | | |