| Certificate Number | 350 | | Date Issued |
| Child Given Name | |
Flynn | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 19 Feb 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | James |
Flynn | Father's Surname |
| Father's Occupation | Laborer | Irish | Father's Nationality |
| Father's Birth Place | Vermont | 34 | Father's Age |
| Mother's Given Name | Elizabeth | Borne | Mother's Maiden Name |
| Mother's Surname | Flynn | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | German | Illinois | Mother's Birth Place |
| Mother's Age | 31 | 5 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Meridith | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Meridith | Ames IA | Certificate Signer's Address |
| Returned by Name | 'By mail' | | |