| Certificate Number | 72 | | Date Issued |
| Child Given Name | Georgia |
Whitaker | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 20 Nov 1888 |
Indian Creek Twp Story Co IA | Place of Birth |
| Father's Given Name | George |
Whitaker | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Iowa | 23 | Father's Age |
| Mother's Given Name | Laura J. | Golden | Mother's Maiden Name |
| Mother's Surname | | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | F. Thompson | Iowa Center IA | Medical Attendant's Address |