| Certificate Number | 249 | | Date Issued |
| Child Given Name | Pearl May |
Banks | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 22 Aug 1888 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | Henry |
Banks | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Canada | 39 | Father's Age |
| Mother's Given Name | Amanda | Taylor | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 4 | Number of Child This Mother |
| Medical Attendant's Name | H.M. Templeton | Ames IA | Medical Attendant's Address |