| Certificate Number | 416 | | Date Issued |
| Child Given Name | Jennie B. |
Gretinger | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 13 Sep 1886 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | N.B. |
Gretinger | Father's Surname |
| Father's Occupation | Mason | | Father's Nationality |
| Father's Birth Place | Ohio | 37 | Father's Age |
| Mother's Given Name | Matissie? | Lyman | Mother's Maiden Name |
| Mother's Surname | Gretinger | | Mother's Residence |
| Mother's Nationality | | Ohio | Mother's Birth Place |
| Mother's Age | 35 | 5 | Number of Child This Mother |
| Medical Attendant's Name | George Stitzell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | George Stitzell | Nevada IA | Certificate Signer's Address |
| Returned by Name | George Stitzell | | |