| Certificate Number | 577 | | Date Issued |
| Child Given Name | |
Huston | Child Surname |
| Child Sex | |
W | Child Race |
| Date of Birth | 12 Jun 1887 |
Collins Story Co IA | Place of Birth |
| Father's Given Name | C.K. |
Huston | Father's Surname |
| Father's Occupation | Farmer | | Father's Nationality |
| Father's Birth Place | Illinois | 36 | Father's Age |
| Mother's Given Name | E. | Rainbow | Mother's Maiden Name |
| Mother's Surname | Huston | Collins Twp Story Co IA | Mother's Residence |
| Mother's Nationality | | Illinois | Mother's Birth Place |
| Mother's Age | 34 | | Number of Child This Mother |
| Medical Attendant's Name | A.P. Edgar | Collins IA | Medical Attendant's Address |