| Certificate Number | 336 | | Date Issued |
| Child Given Name | Birdie B. |
Vanscoy | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Jun 1889 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Vanscoy | Father's Surname |
| Father's Occupation | Horse Doctor | | Father's Nationality |
| Father's Birth Place | Illinois | 28 | Father's Age |
| Mother's Given Name | Elva | Van Dehinder | Mother's Maiden Name |
| Mother's Surname | | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | | Dakota | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | C.A. Beverly | Ames IA | Medical Attendant's Address |