| Certificate Number | 9 | | Date Issued |
| Child Given Name | |
Snowden | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Nov 1891 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Albert L. |
Snowden | Father's Surname |
| Father's Occupation | Druggist | | Father's Nationality |
| Father's Birth Place | Waterloo IA | 24 | Father's Age |
| Mother's Given Name | Grace L. | Austin | Mother's Maiden Name |
| Mother's Surname | Snowden | New York | Mother's Residence |
| Mother's Nationality | | Owasco NY | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.D. Chamberlain | Nevada IA | Medical Attendant's Address |