| Certificate Number | 1009 | | Date Issued |
| Child Given Name | Lourana Orris |
Ward | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Aug 1884 |
Jackson Twp Boone Co IA | Place of Birth |
| Father's Given Name | Ezra |
Ward | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 27 | Father's Age |
| Mother's Given Name | Belle | Briley | Mother's Maiden Name |
| Mother's Surname | Ward | | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton | | |