| Certificate Number | 332 | | Date Issued |
| Child Given Name | Mary Elizabeth |
Collins | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 17 May 1886 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | R.H. |
Collins | Father's Surname |
| Father's Occupation | Gai? | | Father's Nationality |
| Father's Birth Place | Indiana | 32 | Father's Age |
| Mother's Given Name | Josephine H. | Fleming | Mother's Maiden Name |
| Mother's Surname | Collins | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Delaware | Mother's Birth Place |
| Mother's Age | 31 | 5 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | E.B. Plumb | Ames IA | Certificate Signer's Address |
| Returned by Name | E.B. Plumb | | |