| Certificate Number | 8 | | Date Issued |
| Child Given Name | May Fanny |
Tetwiler | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 07 Oct 1884 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Tetwiler | Father's Surname |
| Father's Occupation | Teamster | | Father's Nationality |
| Father's Birth Place | Bedford Co PA | 46 | Father's Age |
| Mother's Given Name | Laura A. | Robison | Mother's Maiden Name |
| Mother's Surname | Tetwiler | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Dekalb Co IN | Mother's Birth Place |
| Mother's Age | 36 | 6 | Number of Child This Mother |
| Medical Attendant's Name | J.H., Dr. Rosenburgh M.D. | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | J.H., Dr. Rosenburgh M.D. | Nevada IA | Certificate Signer's Address |
| Returned by Name | J.H., Dr. Rosenburgh M.D. | | |