| Certificate Number | 38 | | Date Issued |
| Child Given Name | Charlotte |
Taylor | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 14 Nov 1889 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | S.J. |
Taylor | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | | Father's Age |
| Mother's Given Name | Hester E. | Mitchell | Mother's Maiden Name |
| Mother's Surname | | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | | Wisconson | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.A. Mitchell | Maxwell IA | Medical Attendant's Address |