| Certificate Number | 329 | | Date Issued |
| Child Given Name | |
Arrasmith | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 May 1886 |
Gilbert Station Story Co IA | Place of Birth |
| Father's Given Name | George W. |
Arrasmith | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | | 29 | Father's Age |
| Mother's Given Name | Rosa Leah | Smith | Mother's Maiden Name |
| Mother's Surname | Arrasmith | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Rachel Marshall | Gilbert Station IA | Medical Attendant's Address |
| Certificate Signer's Name | Rachel Marshall | Gilbert Station IA | Certificate Signer's Address |
| Returned by Name | Rachel Marshall | | |