| Certificate Number | 72 | | Date Issued |
| Child Given Name | |
Lhommedieu | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 02 Feb 1885 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | D.E.L. |
Hommedieu | Father's Surname |
| Father's Occupation | Bee Keeper | | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Helen I.L. | Thornton | Mother's Maiden Name |
| Mother's Surname | Hommedieu | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 25 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter | | |