| Certificate Number | 320 | | Date Issued |
| Child Given Name | Queen Bell |
Finch | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 01 Oct 1881 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Daniel |
Finch | Father's Surname |
| Father's Occupation | Carpenter | | Father's Nationality |
| Mother's Given Name | Casandra | Hizer | Mother's Maiden Name |
| Mother's Surname | Finch | | Mother's Residence |
| Medical Attendant's Name | E.H. Munk M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Munk M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Munk M.D. | | |