| Certificate Number | 530 | | Date Issued |
| Child Given Name | |
Kegley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 29 Mar 1887 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Cary B. |
Kegley | Father's Surname |
| Father's Occupation | Business | | Father's Nationality |
| Father's Birth Place | Iowa | 30 | Father's Age |
| Mother's Given Name | Augusta | Furguson | Mother's Maiden Name |
| Mother's Surname | Kegley | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |