| Certificate Number | 37 | | Date Issued |
| Child Given Name | |
Wheeler | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 27 Nov 1884 |
Boone Co IA | Place of Birth |
| Father's Given Name | Elihu |
Wheeler | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Maine | 31 | Father's Age |
| Mother's Given Name | Elvira F. | Briley | Mother's Maiden Name |
| Mother's Surname | Wheeler | Boone Co IA | Mother's Residence |
| Mother's Nationality | | Ontario Story Co IA | Mother's Birth Place |
| Mother's Age | 19 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Joseph, Mrs. Wheeler | | Medical Attendant's Address |
| Certificate Signer's Name | Joseph, Mrs. Wheeler | | Certificate Signer's Address |
| Returned by Name | Joseph, Mrs. Wheeler | | |