| Certificate Number | 410 | | Date Issued |
| Child Given Name | Herbert |
Fisher | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Jul 1882 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | Elijah |
Fisher | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 24 | Father's Age |
| Mother's Given Name | Clara A. | Buffington | Mother's Maiden Name |
| Mother's Surname | Fisher | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Mrs. Kent | New Albany Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Mrs. Kent | New Albany Twp IA | Certificate Signer's Address |
| Returned by Name | Elijah Fisher | | |