| Certificate Number | 560 | | Date Issued |
| Child Given Name | Olive |
White | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 May 1887 |
Duff's St Ames Story Co IA | Place of Birth |
| Father's Given Name | Albert L. |
White | Father's Surname |
| Father's Occupation | Tinner | | Father's Nationality |
| Father's Birth Place | Pennsylvania | 35 | Father's Age |
| Mother's Given Name | Sarah Louisa | Glydden | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | New York | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.L., Mrs. Bartlett | Ames IA | Medical Attendant's Address |