| Certificate Number | 104 | | Date Issued |
| Child Given Name | |
Taylor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 08 Feb 1888 |
| Place of Birth |
| Father's Given Name | Wm. |
Taylor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 33 | Father's Age |
| Mother's Given Name | Mary | Wise | Mother's Maiden Name |
| Mother's Surname | | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Returned by Name | E.H. Munk | | |