| Certificate Number | 187 | | Date Issued |
| Child Given Name | Nancy Belle |
Grafton | Child Surname |
| Child Sex | Female |
W | Child Race |
| Date of Birth | 24 Jul 1890 |
Sherman Twp Story Co iA | Place of Birth |
| Father's Given Name | A.H. |
Grafton | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Ohio | 22 | Father's Age |
| Mother's Given Name | Maggie | Dally | Mother's Maiden Name |
| Mother's Surname | | Sherman Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Iowa | Mother's Birth Place |
| Mother's Age | 18 | 1 | Number of Child This Mother |
| Medical Attendant's Name | J.W. Osborn | McCallsburg IA | Medical Attendant's Address |