| Certificate Number | 777 | | Date Issued |
| Child Given Name | Phila Etta |
Taylor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Oct 1882 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Charles E. |
Taylor | Father's Surname |
| Father's Occupation | Insurance Agt. | American | Father's Nationality |
| Father's Birth Place | Pennsylvania | 38 | Father's Age |
| Mother's Given Name | Nancy M. | Wilder | Mother's Maiden Name |
| Mother's Surname | Taylor | | Mother's Residence |
| Mother's Nationality | American | Wisconson | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | D.S. Fairchild | Ames IA | Certificate Signer's Address |
| Returned by Name | D.S. Fairchild | | |