| Certificate Number | 419 | | Date Issued |
| Child Given Name | Effie L. |
Danskin | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 Aug 1882 |
New Albany Twp Story Co IA | Place of Birth |
| Father's Given Name | James |
Danskin | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | New York | 34 | Father's Age |
| Mother's Given Name | Harriet Eliza | Douglas | Mother's Maiden Name |
| Mother's Surname | Danskin | New Albany Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | New York | Mother's Birth Place |
| Mother's Age | 35 | 3 | Number of Child This Mother |
| Medical Attendant's Name | Jno I. Hostetter M.D. | Colo IA | Medical Attendant's Address |
| Certificate Signer's Name | Jno I. Hostetter M.D. | Colo IA | Certificate Signer's Address |
| Returned by Name | Jno I. Hostetter M.D. | | |