| Certificate Number | 56 | | Date Issued |
| Child Given Name | Mada Ina |
Graves | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 15 Dec 1888 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Robt E. |
Graves | Father's Surname |
| Father's Occupation | Miller | | Father's Nationality |
| Father's Birth Place | Iowa | 23 | Father's Age |
| Mother's Given Name | Nellie B. | Byington | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 23 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |