| Certificate Number | 85 | | Date Issued |
| Child Given Name | Nellie |
Griffith | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Mar 1885 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | J.W. |
Griffith | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 32 | Father's Age |
| Mother's Given Name | M.A. | Groseclose | Mother's Maiden Name |
| Mother's Surname | Griffith | Indian Creek Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 30 | 5 | Number of Child This Mother |
| Medical Attendant's Name | J.M. Brown | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | J.M. Brown | Cambridge IA | Certificate Signer's Address |
| Returned by Name | J.M. Brown | | |