| Certificate Number | 485 | | Date Issued |
| Child Given Name | Maude May |
Deal | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Jan 1887 |
Ontario Story Co IA | Place of Birth |
| Father's Given Name | William E. |
Deal | Father's Surname |
| Father's Occupation | Section Hand | | Father's Nationality |
| Father's Birth Place | Indiana | 24 | Father's Age |
| Mother's Given Name | Louisa | McCoy | Mother's Maiden Name |
| Mother's Surname | Deal | Ontario Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 18 | 1 | 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 | | |