| Certificate Number | 340 | | Date Issued |
| Child Given Name | Addie Cecile |
Yonker | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 04 Nov 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Isaac Henry |
Yonker | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 32 | Father's Age |
| Mother's Given Name | Hortense | Cooley | Mother's Maiden Name |
| Mother's Surname | Yonker | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 5 | Number of Child This Mother |
| Medical Attendant's Name | June, Mrs. Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | June, Mrs. Bartlett | Ames IA | Certificate Signer's Address |
| Returned by Name | June, Mrs. Bartlett | | |