| Certificate Number | 389 | | Date Issued |
| Child Given Name | Edna Maude |
Airhart | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 10 Sep 1886 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Geo |
Airhart | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 27 | Father's Age |
| Mother's Given Name | Kate | Pool | Mother's Maiden Name |
| Mother's Surname | Airhart | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Indiana | Mother's Birth Place |
| Mother's Age | 24 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.I. Hostetter | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | J.I. Hostetter | Colo IA | Certificate Signer's Address |
| Returned by Name | J.I. Hostetter | | |