| Certificate Number | 337 | | Date Issued |
| Child Given Name | |
Gearhart | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 05 Jan 1882 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo. D. |
Gearhart | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 21 | Father's Age |
| Mother's Given Name | Ruth E. | Wilhite | Mother's Maiden Name |
| Mother's Surname | Gearhart | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 21 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Geo Frazier M.D. | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Frazier M.D. | Colo IA | Certificate Signer's Address |
| Returned by Name | Geo Frazier M.D. | | |