| Certificate Number | 448 | | Date Issued |
| Child Given Name | |
Casner | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 Sep 1882 |
| Place of Birth |
| Father's Given Name | Gilbert |
Casner | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Iowa | 21 | Father's Age |
| Mother's Given Name | Sarah | Sebastion | Mother's Maiden Name |
| Mother's Surname | Casner | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | | Mother's Birth Place |
| Mother's Age | 16 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Monk M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Monk M.D. | | |