| Certificate Number | 5 | | Date Issued |
| Child Given Name | |
Armstrong | Child Surname |
| Child Sex | Male |
A | Child Race |
| Date of Birth | 26 Jul 1880 |
Nevada Story Co IA | Place of Birth |
| Father's Given Name | C. E. |
Armstrong | Father's Surname |
| Father's Occupation | Grocer | American | Father's Nationality |
| Father's Birth Place | Zansville OH | 32 | Father's Age |
| Mother's Given Name | Emma E. | Whipple | Mother's Maiden Name |
| Mother's Surname | Armstrong | Nevada Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 32 | 3 | Number of Child This Mother |
| Medical Attendant's Name | J.S. Lowell | Nevada IA | Medical Attendant's Address |
| Certificate Signer's Name | J.S. Lowell | Nevada IA | Certificate Signer's Address |
| Returned by Name | J.S. Lowell | | |