| Certificate Number | 8 | | Date Issued |
| Child Given Name | |
Kelfer | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | |
Ontario Story Co IA | Place of Birth |
| Father's Given Name | Abraham |
Kelfer | Father's Surname |
| Father's Occupation | Blacksmith | German | Father's Nationality |
| Father's Birth Place | Pennsylvania | 36 | Father's Age |
| Mother's Given Name | Kesiah | Danels | Mother's Maiden Name |
| Mother's Surname | Kelfer | Ontario Story Co IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 29 | 5 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merideth | Ames IA | Certificate Signer's Address |
| Returned by Name | 'mail' | | |