| Certificate Number | 813 | | Date Issued |
| Child Given Name | |
Crowder | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Dec 1883 |
Hamilton Co IA | Place of Birth |
| Father's Given Name | Isaac |
Crowder | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 32 | Father's Age |
| Mother's Given Name | Allice | Sowers | Mother's Maiden Name |
| Mother's Surname | Crowder | Hamilton Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 26 | 6 | Number of Child This Mother |
| Medical Attendant's Name | B.F Allen | Story City IA | Medical Attendant's Address |
| Certificate Signer's Name | B.F. Allen | Story City IA | Certificate Signer's Address |
| Returned by Name | B.F. Allen | | |