| Certificate Number | 7 | | Date Issued |
| Child Given Name | Elsie M. |
Elliott | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Sep 1888 |
Slater Story Co IA | Place of Birth |
| Father's Given Name | Levi L. |
Elliott | Father's Surname |
| Father's Occupation | Broom maker | | Father's Nationality |
| Father's Birth Place | Indiana | 36 | Father's Age |
| Mother's Given Name | Sarah | Carter | Mother's Maiden Name |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.A. Rawson | Slater IA | Medical Attendant's Address |