| Certificate Number | 145 | | Date Issued |
| Child Given Name | Sylvia May |
Gibson | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 12 May 1890 |
Richland Twp Story Co IA | Place of Birth |
| Father's Given Name | Theodore |
Gibson | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ottawa Il | 27 | Father's Age |
| Mother's Given Name | Mary B. | Adams | Mother's Maiden Name |
| Mother's Surname | | Richland Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Story Co IA | Mother's Birth Place |
| Mother's Age | 20 | 2 | Number of Child This Mother |
| Medical Attendant's Name | J.A. Jeffry | Nevada IA | Medical Attendant's Address |