| Certificate Number | 84 | | Date Issued |
| Child Given Name | |
Weatherby | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Jan 1889 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | D.E. |
Weatherby | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 50 | Father's Age |
| Mother's Given Name | | Miller | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 41 | 6 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |