| Certificate Number | 228 | | Date Issued |
| Child Given Name | Lulu Pearl |
White | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 Sep 1888 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Joseph E. |
White | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 34 | Father's Age |
| Mother's Given Name | Mary E. | Taylor | Mother's Maiden Name |
| Mother's Surname | White | | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |