| Certificate Number | 521 | | Date Issued |
| Child Given Name | |
Airhart | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 20 Feb 1887 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Wallace |
Airhart | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Olive | Cory | Mother's Maiden Name |
| Mother's Surname | Airhart | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 24 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Moule | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Moule | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Moule | | |