| Certificate Number | 572 | | Date Issued |
| Child Given Name | Geneveive |
Heighton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 17 Oct 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | John Henry |
Heighton | Father's Surname |
| Father's Occupation | Painter & Music Dealer | English | Father's Nationality |
| Father's Birth Place | England | 55 | Father's Age |
| Mother's Given Name | Jessie | Wheeler | Mother's Maiden Name |
| Mother's Surname | Heighton | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Jane Bartlett | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | Jane Barlett | Ames IA | Certificate Signer's Address |
| Returned by Name | Jane Bartlett | | |