| Certificate Number | 56 | | Date Issued |
| Child Given Name | Nellie See |
Taylor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Jan 1885 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Geo. |
Taylor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 24 | Father's Age |
| Mother's Given Name | Addie | Fry | Mother's Maiden Name |
| Mother's Surname | Taylor | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 19 | 2 | Number of Child This Mother |
| Medical Attendant's Name | Jno. I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno. I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno. I. Hostetter | | |