| Certificate Number | 59 | | Date Issued |
| Child Given Name | Lassie |
Airhart | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 27 Dec 1889 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Fredrick E. |
Airhart | Father's Surname |
| Father's Occupation | Laborer | | Father's Nationality |
| Father's Birth Place | Rockford Il | 28 | Father's Age |
| Mother's Given Name | Permelia M. | Finch | Mother's Maiden Name |
| Mother's Surname | | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | | Ontario Story Co IA | Mother's Birth Place |
| Mother's Age | 20 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffry | Nevada IA | Medical Attendant's Address |