| Certificate Number | 83 | | Date Issued |
| Child Given Name | |
Templeton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Feb 1890 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | P.J. |
Templeton | Father's Surname |
| Father's Occupation | Farmer | Irish | Father's Nationality |
| Father's Birth Place | Iowa | 33 | Father's Age |
| Mother's Given Name | Malinda | Smith | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | Dutch | Illinois | Mother's Birth Place |
| Mother's Age | 28 | 3 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |