| Certificate Number | 142 | | Date Issued |
| Child Given Name | |
Funk | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 11 Mar 1889 |
Iowa Center Story Co IA | Place of Birth |
| Father's Given Name | C.A. |
Funk | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 34 | Father's Age |
| Mother's Given Name | Rachel E. | McCord | Mother's Maiden Name |
| Mother's Surname | | Iowa Center Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 27 | 2 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor | Maxwell Ia | Medical Attendant's Address |