| Certificate Number | 172 | | Date Issued |
| Child Given Name | Lois Dell |
Dunkle | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Oct 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Dunkle | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 31 | Father's Age |
| Mother's Given Name | Matilda Ann | Sims | Mother's Maiden Name |
| Mother's Surname | Dunkle | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 28 | 4 | 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 | | |