| Certificate Number | 4 | | Date Issued |
| Child Given Name | Dora |
Airhart | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 04 Oct 1888 |
Milford Twp Story Co IA | Place of Birth |
| Father's Given Name | David C. |
Airhart | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 23 | Father's Age |
| Mother's Given Name | Dora | Cory | Mother's Maiden Name |
| Mother's Surname | | Grant Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | E.H. Munk | Nevada IA | Medical Attendant's Address |