| Certificate Number | 147 | | Date Issued |
| Child Given Name | Mary Louise |
Patton | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 05 Apr 1881 |
Collins Twp Story Co IA | Place of Birth |
| Father's Given Name | Edward |
Patton | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | 32 | Father's Age |
| Mother's Given Name | Harriet | Marcelus | Mother's Maiden Name |
| Mother's Surname | Patton | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | L.W. Thomas | Edenville IA | Medical Attendant's Address |
| Certificate Signer's Name | L.W. Thomas | Edenville IA | Certificate Signer's Address |
| Returned by Name | L.W. Thomas | | |