| Certificate Number | 334 | | Date Issued |
| Child Given Name | |
Taylor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 23 Sep 1886 |
| Place of Birth |
| Father's Given Name | William |
Taylor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 34 | Father's Age |
| Mother's Given Name | Mary E. | Wise | Mother's Maiden Name |
| Mother's Surname | Taylor | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 30 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Monk | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | E.H. Monk | Nevada IA | Certificate Signer's Address |
| Returned by Name | E.H. Monk | | |