| Certificate Number | 348 | | Date Issued |
| Child Given Name | |
Newton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 30 Sep 1889 |
Zearing Story Co IA | Place of Birth |
| Father's Given Name | F.S. |
Newton | Father's Surname |
| Father's Occupation | Physician | | Father's Nationality |
| Father's Birth Place | Vermont | 33 | Father's Age |
| Mother's Given Name | | Burdick | Mother's Maiden Name |
| Mother's Surname | | Zearing Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | F.S. Newton | Zearing IA | Medical Attendant's Address |