| Certificate Number | 376 | | Date Issued |
| Child Given Name | |
Robinson | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 09 Apr 1882 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Joseph B. |
Robinson | Father's Surname |
| Father's Occupation | Laborer | American | Father's Nationality |
| Father's Birth Place | Iowa | 23 | Father's Age |
| Mother's Given Name | Minnie V. | Elwell | Mother's Maiden Name |
| Mother's Surname | Robinson | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Illinois | Mother's Birth Place |
| Mother's Age | 20 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Lewis Schooler | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | Lewis Schooler | Nevada IA | Certificate Signer's Address |
| Returned by Name | Lewis Schooler | | |