| Certificate Number | 148 | | Date Issued |
| Child Given Name | |
Danner | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 06 Apr 1889 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | W.W. |
Danner | Father's Surname |
| Father's Occupation | Minister | | Father's Nationality |
| Father's Birth Place | Ohio | 37 | Father's Age |
| Mother's Given Name | Nancy M. | Scott | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 25 | 2 | Number of Child This Mother |
| Medical Attendant's Name | L.C., Mrs. Butt | Nevada IA | Medical Attendant's Address |