| Certificate Number | 704 | | Date Issued |
| Child Given Name | |
Dunlap | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 03 Jul 1883 |
Maxwell Story Co IA | Place of Birth |
| Father's Given Name | James |
Dunlap | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 41 | Father's Age |
| Mother's Given Name | Charlotte F. | Walker | Mother's Maiden Name |
| Mother's Surname | Dunlap | Maxwell Story Co IA | Mother's Residence |
| Mother's Nationality | American | Iowa | Mother's Birth Place |
| Mother's Age | 26 | 6 | Number of Child This Mother |
| Medical Attendant's Name | P. Joor M.D. | Maxwell Ia | Medical Attendant's Address |
| Certificate Signer's Name | P. Joor M.D. | Maxwell Story Co IA | Certificate Signer's Address |
| Returned by Name | P. Joor M.D. | | |