| Certificate Number | 39 | | Date Issued |
| Child Given Name | |
Farrington | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 25 Sep 1880 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | Ensley F. |
Farrington | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | North Carolina | 55 | Father's Age |
| Mother's Given Name | Annie | Cox | Mother's Maiden Name |
| Mother's Surname | Farrington | Nevada Twp Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 42 | | Number of Child This Mother |
| Medical Attendant's Name | S.C. Bust | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | S.C. Bust | Nevada IA | Certificate Signer's Address |
| Returned by Name | S.C. Bust | | |