| Certificate Number | 59 | | Date Issued |
| Child Given Name | Daisy Athelia |
Taylor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 16 Oct 1887 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | George |
Taylor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 26 | Father's Age |
| Mother's Given Name | Addie | Fry | Mother's Maiden Name |
| Mother's Surname | Taylor | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 21 | | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |