| Certificate Number | 97 | | Date Issued |
| Child Given Name | |
Harding | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 14 Dec 1880 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | Robert B. |
Harding | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 35 | Father's Age |
| Mother's Given Name | America J. | Wyatt | Mother's Maiden Name |
| Mother's Surname | Harding | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 29 | 4 | Number of Child This Mother |
| Medical Attendant's Name | Geo Frazee | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Geo Frazee | Colo IA | Certificate Signer's Address |
| Returned by Name | 'Mail' | | |