| Certificate Number | 678 | | Date Issued |
| Child Given Name | Sarah Ann |
McLain | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 31 May 1883 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | John |
McLain | Father's Surname |
| Father's Occupation | Barber | American | Father's Nationality |
| Father's Birth Place | Illinois | 25 | Father's Age |
| Mother's Given Name | Irene | Page | Mother's Maiden Name |
| Mother's Surname | McLain | Zearing Story Co IA | Mother's Residence |
| Medical Attendant's Name | Fanny McLain | Warren Twp IA | Medical Attendant's Address |
| Certificate Signer's Name | Fanny McLain | Warren Twp IA | Certificate Signer's Address |
| Returned by Name | Fanny McLain | | |