| Certificate Number | 136 | | Date Issued |
| Child Given Name | |
Fisher | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 18 Mar 1881 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Nathan T. |
Fisher | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Lake Co OH | 27 | Father's Age |
| Mother's Given Name | Sabra Jane | Johnson | Mother's Maiden Name |
| Mother's Surname | Fisher | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Clinton Co OH | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.S. Lowell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | J.S. Lowell | Nevada IA | Certificate Signer's Address |
| Returned by Name | J.S. Lowell | | |