| Certificate Number | 223 | | Date Issued |
| Child Given Name | Ella |
Watts | Child Surname |
| Child Sex | Female |
| Child Race |
| Date of Birth | 31 Jan 1881 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | John |
Watts | Father's Surname |
| Father's Occupation | Editor of Ames Intelligencer | American | Father's Nationality |
| Father's Birth Place | | 37 | Father's Age |
| Mother's Given Name | Alice E. | Cook | Mother's Maiden Name |
| Mother's Surname | Watts | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Otsego NY | Mother's Birth Place |
| Mother's Age | 30 | 5 | Number of Child This Mother |
| Medical Attendant's Name | D.S. Fairchild | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | D.S. Fairchild | Ames IA | Certificate Signer's Address |
| Returned by Name | D.S. Fairchild | | |