| Certificate Number | 185 | | Date Issued |
| Child Given Name | Cora May |
Shockley | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 31 Oct 1885 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Jacob A. |
Shockley | Father's Surname |
| Father's Occupation | R.R. | | Father's Nationality |
| Father's Birth Place | Indiana | 40 | Father's Age |
| Mother's Given Name | Julittie R. | Baldwin | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 34 | 10 | Number of Child This Mother |
| Medical Attendant's Name | G.A. Meredith | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | G.A. Meredith | Ames IA | Certificate Signer's Address |
| Returned by Name | G.A. Meredith | | |