| Certificate Number | 136 | | Date Issued |
| Child Given Name | Edith Dora |
Hughs | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Jun 1885 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | Ellis J. |
Hughs | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 28 | Father's Age |
| Mother's Given Name | Ella | Squire | Mother's Maiden Name |
| Mother's Surname | Hughs | Milford Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 3 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merridith | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merridith | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merridith | | |