| PLACE OF TRANSCRIPTION: | Walworth County Courthouse |
| ADDRESS: | Courthouse Square, PO Box 1001 |
| CITY, STATE, ZIP: | Elkhorn, WI 53121 |
| PHONE NUMBER: | |
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| COUNTY: | Walworth |
| VOLUME: | 3 |
| PAGE: | 12 |
| RECORD NO: | 34 |
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| REEL #: | |
| RECORD #: | |
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| 1. Full Name of Child | ----- |
| 2. Sex | Female |
| 3. Color | White |
| 4. Name of other Issue(s) Living: | Harley |
| 5. Full Name of Father: | Gerry Barker |
| 6. Occupation of Father: | Farmer |
| 7. Full Name of Mother Previous to Marriage: | Diantha Gibbs |
| 8. Hour, Day of Week, of Month, and Year of Birth: | 7 a.m., Sunday, April 27, 1884 |
| 9. Place, Town or Township, and County in Which Born: | LaGrange, Walworth Co., Wis. |
| 10. Name of Physician or Person Signing the Certificate or on Whose Application Registry is Made: | C. L. Miller, M.D. (?) |
| 13. Residence of Such Person: | Whitewater, Wis. |
| 14. Date of Certificate: | ----- |
| 15. Date of Registration: | July 9-1884 |
| 16. Any Additional Circumstances: | ----- |