| Certificate Number | 584 | | Date Issued |
| Child Given Name | Olga Ann |
Carr | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 12 Dec 1882 |
Collins Story Co IA | Place of Birth |
| Father's Given Name | Wyatt |
Carr | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Illinois | | Father's Age |
| Mother's Given Name | Ellen | Angelo | Mother's Maiden Name |
| Mother's Surname | Carr | Collins Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 31 | 2 | Number of Child This Mother |
| Medical Attendant's Name | A.W. Knepper | Collins IA | Medical Attendant's Address |
| Certificate Signer's Name | A.W. Knepper | Collins IA | Certificate Signer's Address |
| Returned by Name | A.W. Knepper | | |