| Certificate Number | 757 | | Date Issued |
| Child Given Name | |
Gatrell | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 20 Nov 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Chas |
Gatrell | Father's Surname |
| Father's Occupation | Moulder | American | Father's Nationality |
| Father's Birth Place | Ohio | 32 | Father's Age |
| Mother's Given Name | Mrs. Chas. | | Mother's Maiden Name |
| Mother's Surname | Gatrell | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Ohio | Mother's Birth Place |
| Mother's Age | 30 | 3 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | C.A. Beverly | Ames IA | Certificate Signer's Address |
| Returned by Name | C.A. Beverly | | |