| Child Given Name | |
Walters | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Jul 1885 |
Franklin Twp Story Co IA | Place of Birth |
| Father's Given Name | Samuel M. |
Walters | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 29 | Father's Age |
| Mother's Given Name | Louisa A. | Coon | Mother's Maiden Name |
| Mother's Surname | Walters | Franklin Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 26 | 1 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton M.D. | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | H.M. Templeton M.D. | Ames IA | Certificate Signer's Address |
| Returned by Name | H.M. Templeton M.D. | | |