| Certificate Number | 797 | | Date Issued |
| Child Given Name | Daisy D. |
Nanning | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Oct 1883 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | J.M |
Nanning | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Indiana | 41 | Father's Age |
| Mother's Given Name | Abbey | Smith | Mother's Maiden Name |
| Mother's Surname | Nanning | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 37 | 10 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | J.I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | J.I. Hostetter | | |