| Certificate Number | 470 | | Date Issued |
| Child Given Name | Edna Maude |
Ashford | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Oct 1882 |
Nevada Twp Story Co IA | Place of Birth |
| Father's Given Name | Genio Bailey |
Ashford | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 25 | Father's Age |
| Mother's Given Name | Mary Josephine | Stephenson | Mother's Maiden Name |
| Mother's Surname | Ashford | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Vermont | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Lewis Schooler M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Lewis Schooler M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | Lewis Schooler M.D. | | |