| Certificate Number | 52 | | Date Issued |
| Child Given Name | Ada May |
Barker | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Jan 1885 |
Union Twp Story Co IA | Place of Birth |
| Father's Given Name | Clarles |
Barker | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | New York | 29 | Father's Age |
| Mother's Given Name | Emily Ann | Eastman | Mother's Maiden Name |
| Mother's Surname | Barker | Union Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 23 | 2 | Number of Child This Mother |
| Medical Attendant's Name | D.D. Hays | Cambridge IA | Medical Attendant's Address |
| Certificate Signer's Name | D.D. Hays | Cambridge IA | Certificate Signer's Address |
| Returned by Name | D.D. Hays | | |