| Certificate Number | 567 | | Date Issued |
| Child Given Name | Lucy Ann |
Tagatoff | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 18 May 1887 |
Lincoln Twp Story Co IA | Place of Birth |
| Father's Given Name | Francis |
Tagatoff | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Iowa | 29 | Father's Age |
| Mother's Given Name | Anna Eliza | Dunn | Mother's Maiden Name |
| Mother's Surname | Tagatoff | Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 22 | 1 | Number of Child This Mother |
| Medical Attendant's Name | Z. Carey | Bangor IA | Medical Attendant's Address |