| Certificate Number | 196 | | Date Issued |
| Child Given Name | Jennie B. |
Howe | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 23 Apr 1881 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | James Martin |
Howe | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Butte Co PA | 28 | Father's Age |
| Mother's Given Name | Bettie Maranda | Gilleth | Mother's Maiden Name |
| Mother's Surname | Howe | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 26 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Jas Howe | Richland Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Jas Howe | Richland Twp IA | Certificate Signer's Address |