| Certificate Number | 971 | | Date Issued |
| Child Given Name | Luella Blanche |
Robb | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 Jun 1884 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | James |
Robb | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 33 | Father's Age |
| Mother's Given Name | Anna M. | Nelson | Mother's Maiden Name |
| Mother's Surname | Robb | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Pennsylvania | Mother's Birth Place |
| Mother's Age | 30 | 2 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Merrideth | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Merrideth | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Merrideth | | |