| Certificate Number | 49 | | Date Issued |
| Child Given Name | |
Will | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Dec 1887 |
Iowa Center Story Co IA | Place of Birth |
| Father's Given Name | John W. |
Will | Father's Surname |
| Father's Occupation | Merchant | | Father's Nationality |
| Father's Birth Place | West Virginia | 43 | Father's Age |
| Mother's Given Name | Hattie | Higley | Mother's Maiden Name |
| Mother's Surname | Will | Iowa Center Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 41 | 7 | Number of Child This Mother |
| Certificate Signer's Name | Frank Thompson | Iowa Center IA | Certificate Signer's Address |