| Certificate Number | 43 | | Date Issued |
| Child Given Name | |
Duntz | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Nov 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Chas A. |
Duntz | Father's Surname |
| Father's Occupation | Carpenter | | Father's Nationality |
| Father's Birth Place | New York | 30 | Father's Age |
| Mother's Given Name | Alma A. | Hunter | Mother's Maiden Name |
| Mother's Surname | Duntz | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |