| Certificate Number | 71 | | Date Issued |
| Child Given Name | Alice |
Elliott | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 26 Oct 1888 |
Grant Twp Story Co IA | Place of Birth |
| Father's Given Name | J.F. |
Elliott | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Indiana | 36 | Father's Age |
| Mother's Given Name | Ida | Chandler | Mother's Maiden Name |
| Mother's Nationality | | Maine | Mother's Birth Place |
| Mother's Age | 33 | 5 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |